Medication adherence and blood pressure control amongst adults with primary hypertension attending a tertiary hospital primary care clinic in Eastern Nigeria

Gabriel U.P. Iloh,John N. Ofoedu,Agwu N. Amadi,Patrick U. Njoku,Ezinne U. Godswill-Uko

doi:10.4102/phcfm.v5i1.446

Gabriel U.P. Iloh, John N. Ofoedu + Show 3 more

Open Access

https://doi.org/10.4102/phcfm.v5i1.446

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Abstract

BackgroundAs the case detection rates of hypertension increase in adult Nigerians, achieving target blood pressure (BP) control has become an important management challenge.ObjectivesTo describe medication adherence and BP control amongst adult Nigerians with primary hypertension attending a primary care clinic of a tertiary hospital in a resource-poor environment in Eastern Nigeria.MethodsA cross-sectional study was carried out in 140 adult patients with primary hypertension who have been on treatment for at least 6 months at the primary care clinic of Federal Medical Centre, Umuahia. A patient was said to have achieved goal BP control if the BP was < 140 per 90 mmHg. Adherence was assessed in the previous 30 days using a pretested researcher-administered questionnaire on 30 days of self-reported therapy. Adherence was graded using an ordinal scoring system of 0–4; an adherent patient was one who scored 4 points in the previous 30 days. Reasons for non-adherence were documented.ResultsAdherence to medication and BP control rates were 42.9% and 35.0% respectively. BP control was significantly associated with medication adherence (p = 0.03), antihypertensive medication duration ≥3 years (p = 0.042), and taking ≥ one form of antihypertensive medication (p = 0.04). BP at the recruitment visit was significantly higher than at the end of the study (p = 0.036). The most common reason for non-adherence was forgetfulness (p = 0.046).ConclusionsThe rate of BP control amongst the study population was low, which may be connected with low medication adherence. This study urges consideration of factors relating to adherence alongside other factors driving goal BP control.

Highlights

Hypertension is the most common cardiovascular disorder, posing a major clinical and public health challenge to populations in socio-economic and demographic transition.[1]
The blood pressure (BP) control rate in this study of 35.0% is higher than the 24.2% reported in Port Harcourt, Rivers State, south-south Nigeria,10 31.4% reported in Osogbo, south-west Nigeria,[11] and 33% reported in Kano, Northern Nigeria.[14]
The BP control rate in this study is lower than the 35.8% reported in Ilorin, North Central Nigeria[13] and 40.0% reported in South Africa.[25]

Summary

Introduction

Hypertension is the most common cardiovascular disorder, posing a major clinical and public health challenge to populations in socio-economic and demographic transition.[1]. Hypertension is one of the most common causes of disability and death amongst the adult Nigerian population, and plays an important role in the causation of hypertensive heart failure, heart attack, arteriosclerosis, renal failure and stroke.[4] Adequate control of BP was reported to reduce the incidence of stroke by an average of 35% – 40%, myocardial infarction by 20% – 25% and heart failure by more than 50%.5. As the case detection rates of hypertension increase in adult Nigerians, achieving target blood pressure (BP) control has become an important management challenge

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