Abstract P162: Drug Adherence In Hypertensive Patients And Variables Associated With Nonadherence.

Abstract

Introduction: The prevalence of systemic hypertension has increased considerably in India over the past few decades from 5 percent to between 20-40 percent in urban population and 12-17 percent in rural population. Although there is availability of numerous affordable antihypertensive drugs, hypertension is still poorly controlled, leading to an epidemic of non-communicable diseases. Drug nonadherence is implicated as a major factor responsible for poorly controlled hypertension. Aim: This study was undertaken to gather data regarding drug adherence among hypertensive cohort and factors responsible for poor adherence. Methods: We prospectively studied 1468 hypertensive patients at a tertiary care hospital. Assessment of antihypertensive medication adherence was determined using the instrument validated by Morisky et al. Poor medication adherence was defined as answering yes to three or more of eight questions. Office reading and 24-hr ABPM were used to assess the level of hypertension control. Result: The mean age of the included patients was 61.2 ± 10.6 years and 63.5 % were male. Among the studied cohort, 55.8 % (819 out of 1468) patients were highly adherent to antihypertensive medication and adequate BP control was achieved in only 39.10 % (574 out of 1468) patients. Independent predictors of drug non-adherence in a multivariate analysis model were illiteracy (hazard ratio [HR] 3.06; 95% confidence interval [CI], 1.31-7.16), low socioeconomic status (HR 2.6; 95% CI, 1.28-4.89), presence of drug side effect (HR 1.7; 95% CI, 1.54-1.95), number of drugs (HR 1.8; 95% CI, 1.4-2.2), number of years on treatment (HR 1.4; 95% CI, 1.1-1.8), incognizant of long term risk of uncontrolled hypertension (HR 1.5; 95% CI, 1.31-1.74), irregular BP monitoring (HR 1.3; 95% CI, 1.1-1.6), and associated CKD and/or DM (HR 2.74; 95% CI, 1.065-7.05) Conclusion: Antihypertensive drug non adherence is a prevalent behavior among patients and since many of the attributed factors are modifiable, they signal opportunities to improve adherence, and thus, BP control in clinical practice