Hypertension knowledge, medication adherence, and BP control in community-dwelling hypertensive older adults: a cross-sectional study

Background Hypertension affects 31.6% of Chinese adults, yet medication nonadherence (30-50%) remains a critical barrier to control. The purpose of this study is to explore the relationship between hypertension knowledge, medication adherence, and lifestyle factors, and their associations with blood pressure control in older hypertensive patients living in the community. Methods Cross-sectional study of 437 hypertensive patients (≥ 65 years) in Taizhou, China (Oct-Dec 2023). Medication adherence was assessed via composite score (0–8, > 6 = good) from four validated questions. Hypertension knowledge was evaluated through structured questionnaires. Data were analyzed using SPSS 26. Results Only 35.3% demonstrated good adherence. Intentional non-adherence behaviors (skipping doses, stopping when asymptomatic) and difficulty remembering medications were significantly associated with poor blood pressure control (p < 0.05). Blood pressure control correlated with salt/fat intake regulation and sleep quality (p < 0.001). Polypharmacy, driven by comorbidities, created adherence challenges. Conclusions Poor medication adherence, driven primarily by intentional behaviors (e.g., dose skipping, stopping when asymptomatic) and regimen complexity, is strongly associated with poor blood pressure control. Effective interventions must address these specific behavioral and systemic barriers to improve hypertension management in older adults.