Behavioral Factors Associated with Medication Nonadherence in Patients with Hypertension.

Shu-Mei Chang,Yin-Jin Lin,Yi-Chun Chen,Hung-Yi Chuang,Chin-Feng Hsuan,I-Cheng Lu

doi:10.3390/ijerph18189614

Abstract

Medication nonadherence is associated with an increased risk of complications in hypertensive patients. We investigated behavioral factors associated with medication nonadherence in hypertensive patients in southern Taiwan. Using questionnaires, we collected data regarding clinicodemographic characteristics and nonadherence behaviors from 238 hypertensive patients. We assessed the self-reported prevalence of specific behaviors of medication nonadherence and investigated factors associated with each behavior using multivariable logistic regression analysis. The most common behavior of medication nonadherence was forgetting to take medication (28.6%), followed by discontinuing medication (9.2%) and reducing the medication dose (8.8%). Age ≥ 65 years (adjusted odds ratio [aOR] = 0.32, 95% confidence interval [CI] = 0.15–0.69) and male sex (aOR = 2.61, CI = 1.31–5.19) were associated with forgetting to take medication. The presence of comorbidities (diabetes, kidney disease, or both) and insomnia (aOR = 3.97, 95% CI = 1.30–12.1) was associated with reducing the medication dose. The use of diet supplements was associated with discontinuing the medication (aOR = 4.82, 95% CI = 1.50–15.5). Compliance with a low oil/sugar/sodium diet was a protective factor against discontinuing medication (aOR = 0.14; 95% CI = 0.03–0.75). The most pervasive behavior associated with medication nonadherence among hypertensive patients was forgetting to take medication. Age <65 years, male sex, comorbidities, insomnia, noncompliance with diet, and the use of dietary supplements were specifically associated with medication nonadherence.

Highlights

Hypertension is the main risk factor for cardiovascular disease, stroke, diabetes, and kidney disease worldwide [1], and its attributable burden of disease is greater than that of other risk factors, such as smoking and obesity [2]
Good compliance with a low oil/sugar/sodium diet was associated with a lower risk of discontinuing medication
Lin et al [17] found that compared to female patients, male patients with diabetes were associated with poorer medication adherence, and another study found that the male patients in Taiwan had lower adherence to daily food guides [18]

Summary

Introduction

Hypertension is the main risk factor for cardiovascular disease, stroke, diabetes, and kidney disease worldwide [1], and its attributable burden of disease is greater than that of other risk factors, such as smoking and obesity [2]. It is a preventable disease that leads to significant disability and premature death [3], and adherence to its treatment protocol is essential to decrease the risk of complications, such as cardiovascular disease, cerebrovascular disease, diabetes, chronic kidney disease, and retinopathy [4,5,6]. Medication nonadherence in patients with hypertension is a major public health issue. In this regard, a survey including 24 million patients with hypertension in the United States has shown that 31% were nonadherent to medication [7].

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