Abstract
BackgroundMany patients with hypertension require more than one drug to achieve blood pressure control. They are prescribed with fixed-dose combination (FDC) antihypertensive therapy rather than monotherapies. Although it is commonly admitted that the use of FDC may improve compliance to treatment, adherence rates in patients receiving FDCs have not been documented. Therefore, the aim of this study was to assess the adherence to treatment in patients receiving FDCs of antihypertensive medications in a real-world setting in Egypt.ResultsWe conducted a multi-center cross-sectional study over a period of 1 year from Jan 2017 to Jan 2018. We included patients above 21 years old with essential hypertension who were already prescribed with an FDC of antihypertensive treatment for at least 3-month duration. We assessed the adherence to treatment by patient self-assessment using the Morisky 8-Item Medication Adherence Scale (MMAS 8).This study enrolled 2000 hypertensive Egyptian patients. The mean age of enrolled patients was 55.8 ± 10.9 years. Male to female ratio was 1.08. The mean MMAS score was 6.5 ± 1.9. Our analysis showed that 825 (41.3%) patients reached high adherence score, 523 (26.2%) medium adherence, and 652 (32.6%) low adherence.Furthermore, Male patients showed higher adherence rate than females (56.4% versus 43.6%, p < 0.001). Out of 746 patients with controlled blood pressure (< 140/90), 387 (51.9%) patients were highly adherent to treatment. Higher level of education was significantly associated with high adherence rate; 559 (67.8%) patients were university graduates, 232 (28.1%) had primary/secondary school education, and 34 (4.1%) were illiterate (p < 0.001).Moreover, once daily (99.2%) fixed-dose combination was associated with higher adherence rate than twice regimen daily (0.8%), p = 0.03. Multivariate logistic regression analysis showed that patients with high level of education, employed patients, and patients with controlled blood pressure have high adherence rate to medication.ConclusionsHigher adherence to medication is associated with high level of education and employment, and it can lead to better blood pressure control. Thus, patient education programs may increase patients’ adherence to their medication.
Highlights
Many patients with hypertension require more than one drug to achieve blood pressure control
The 2018 European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) guidelines reported that the following drugs demonstrated effective reduction of blood pressure (BP) and cardiovascular events (CV): calcium channel blockers (CCBs), betablockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and diuretics [6]
They recommended combination therapy (ACE inhibitor or an ARB with a CCB or diuretic) as initial therapy for most hypertensive patients [7]. They stated that patients should be subjected to a three-drug combination if BP not controlled on a two-drug combination [8]
Summary
Many patients with hypertension require more than one drug to achieve blood pressure control. The 2018 European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) guidelines reported that the following drugs demonstrated effective reduction of blood pressure (BP) and cardiovascular events (CV): calcium channel blockers (CCBs), betablockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and diuretics [6]. They recommended combination therapy (ACE inhibitor or an ARB with a CCB or diuretic) as initial therapy for most hypertensive patients [7]. They stated that patients should be subjected to a three-drug combination if BP not controlled on a two-drug combination [8]
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