Determinants of therapeutic nonadherence in Tunisian hypertensive patients in the rural population

Abstract

Poor adherence to antihypertensive treatment is one of the major factors of poor blood pressure control, particularly in rural areas. The objectives of our study were to assess treatment adherence and identify factors associated with poor adherence in rural areas. We carried out a cross-sectional descriptive study carried out in a regional hospital in Kasserine during the months of January and February 2021. We measured therapeutic compliance using the Girerd questionnaire and we studied the associations between poor blood pressure medications adherence and demographic, socioeconomic, hygieno-dietetic and therapeutic covariates. One hundred patients were included. The mean age was 66.86 years ± 11.97 with a sex ratio of 2.33. Factors associated with poor adherence were age ≥ 65 years ( P = 0.007), hypertension duration more than 1 year ( P = 0.008), physical inactivity ( P < 0.001), diabetes ( P = 0.024), history of stroke and/or heart disease ( P < 0.001), treatment with a number ≥ 2 of antihypertensive drugs ( P = 0.0035), without a fixed association ( P = 0.040), existence of adverse effects (0.034) and treatment with ACE inhibitors (0.015). On the other hand, we did not find a significant effect of sex, educational level, type of medical insurance and adherence to the low-sodium diet on therapeutic adherence, whereas treatment with ARB was significantly associated with better adherence ( P = 0.018). Our study found poor adherence in this rural population with a low socioeconomic level, with more significant problems found in elderly, poly-pathological subjects treated with several antihypertensive drugs, a fortiori without a fixed association. To improve drug adherence, it is important to include therapeutic education programs adapted to the socioeconomic level of this population in the therapeutic arsenal.