The role of family functioning and psychological well-being in adherence to antihypertensive treatment

The main objective of this study is to examine the explanatory models that link family functioning and psychological well-being with adherence to antihypertensive treatment. High blood pressure remains a critical global public health challenge, particularly in Latin America, where control rates often fall below international standards due to complex psychosocial barriers. Methods: This study adopted a qualitative systematic review design following the PRISMA protocol. A total of 43 articles published between 2020 and 2024 were identified across PubMed, Scopus, Web of Science, and SciELO. Data were analyzed using qualitative thematic analysis, supported by ATLAS.ti and VOSviewer to map conceptual clusters and bibliographic networks. The findings reveal that therapeutic adherence is a multidimensional phenomenon shaped by interrelated factors. The bibliometric analysis identified a peak in scientific production in 2024, which represented 25.6% of the studies. High levels of family cohesion and effective communication were consistently associated with improved adherence, whereas family conflict and excessive control constituted significant barriers. At the psychological level, anxiety, depression, and chronic stress reduced adherence, while resilience and perceived control operated as protective mechanisms. Integrative models showed that family dynamics modulate individual psychological states, which demonstrates that isolated biomedical perspectives are insufficient to explain patient behavior. Adherence depends on a complex interaction among clinical, family, and psychological dimensions. To improve cardiovascular outcomes, health systems must move toward systemic and family-centered intervention models that combine biomedical care with social and emotional support. These findings provide a more comprehensive framework for the design of effective public health policies and community-based programs.