Non-adherence to antihypertensive medication and its associated factors among cardiac patients at Alshaab Referred Clinic, November 2017

Abstract

Background: Non-adherence to antihypertensive drugs is identified to have negative impact on cardiovascular outcome. Various studies have been conducted on this issue worldwide but data about medications adherence and its associated factors in Sudan are limited.

Objectives: The objectives of this study are to identify the prevalence and factors associated with non-adherence to antihypertensive medications among cardiac patients in Sudan.

Methods: A descriptive cross-sectional study was conducted on 202 patients by total coverage of all diagnosed hypertensive patients with cardiac disease who attended the referred clinic at Alshaab teaching hospital during the study period from November 5th to December 7th, 2017. Data were collected by direct interview of the patients using structured questionnaire, clinical characteristics of the patients were obtained from the medical records, WISEWOMAN medications adherence questionnaire for hypertension was used to assess the level of medication adherence. Descriptive and multivariate logistic regression was used for data analysis, using SPSS version 20.

Results: Out of 202 participants, 140 (69.3%) were female, the mean age of the participants was 60.74 ± 13.6. The study revealed that 41.6% of the patients were nonadherent to their antihypertensive medications, the level of non-adherence was found to be significantly associated with young age (p-value < 0.012), high level of education (p-value < 0.05), and using more than one pharmacy to get the medications (p-value < 0.00); after logistic regression analysis, non-adherence was found to be significantly associated with using more than one pharmacy to get the medications (p-value < 0.00). The level of non-adherence in our study is found to be corresponding to the findings of other similar local, regional, and international studies, which have reported that non-adherence of medication ranged between 39.5% and 55.9%. Other factors in different studies were found to be significantly associated with non-adherence such as gender, duration of hypertension, duration between follow-up visits to physician and number of drugs.

Conclusion: The study results show high prevalence of non-adherence; this is associated more with using more than one pharmacy to get the medications, young age, and higher level of education. In order to improve the adherence to antihypertensive medications in our country, we recommend the use of medications adherence scale as routine tool in the outpatient clinic to identify the non-adherent patients. Doctors must make sure that the drugs are available in the pharmacies around their area before prescription, and to conduct more studies to identify the barriers to adherence specially in young and educated patients.

Keywords: non-adherence, antihypertensive medications, cardiac patients, associated factors