Abstract
BackgroundHypertension is a challenging public health problem with a huge burden in the developing countries. Non-adherence to antihypertensive treatment is a big obstacle in blood pressure (BP) control and favours disease progression to complications. Our objectives were to determine the rate of non-adherence to antihypertensive pharmacotherapy, investigate factors associated with non-adherence, and to assess the association between non-adherence and BP control in the Buea Health District (BHD), Cameroon.MethodsA community-based cross-sectional study using stratified cluster sampling was conducted in the BHD from November 2013 – March 2014. Eligible consenting adult participants had their BP measured and classified using the Joint National Committee VII criteria. The Morisky medication adherence scale was used to assess adherence to BP lowering medication. Multivariable logistic regression models were used to predict non-adherence.ResultsOne hundred and eighty-three participants were recruited with mean age of 55.9 years. Overall, 67.7% (95% CI: 59.8–73.6%) of participants were non-adherent to their medications. After adjusting for age, sex and other covariates, forgetfulness (aOR = 7.9, 95%CI: 3.0–20.8), multiple daily doses (aOR = 2.5, 95%CI: 1.2–5.6), financial constraints (aOR = 2.8, 95%CI: 1.1–6.9) and adverse drug effects (aOR = 7.6, 95%CI: 1.7–33.0) independently predicted non-adherence to anti-hypertensive medication. BP was controlled in only 21.3% of participants and was better in those who were adherent to medication (47.5% versus 8.2%, p < 0.01).ConclusionAt least two of every three hypertensive patients in the Buea Health District are non-adherent to treatment. Forgetfulness, multiple daily doses of medication, financial constraints and medication adverse effects are the major predictors of non-adherence in hypertensive patients. These factors should be targeted to improve adherence and BP control, which will contribute to stem hypertension-related morbidity and mortality.
Highlights
Hypertension is a challenging public health problem with a huge burden in the developing countries
We found that forgetfulness (adjusted odds ratio = 7.9; 95% confidence interval (CI): 3–20.8, p < 0.001), lack of finances, multiple daily doses and drug side effects were independent predictors of non-adherence after controlling for potential confounders in multivariate analysis
In this community-based study assessing adherence to antihypertensive medication among adults in the Buea Health District (BHD), we found that two-thirds of our study participants were non-adherent to antihypertensive pharmacotherapy and this was mainly driven by forgetfulness to take medications, lack of funds to buy medications, antihypertensive regimens requiring multiple daily dosing and drug side effects
Summary
Hypertension is a challenging public health problem with a huge burden in the developing countries. Our objectives were to determine the rate of non-adherence to antihypertensive pharmacotherapy, investigate factors associated with non-adherence, and to assess the association between nonadherence and BP control in the Buea Health District (BHD), Cameroon. In 2010, the global prevalence of hypertension was estimated at 1.39 billion representing 31.1% in the adult population [1]. This implies one in three adults suffer from hypertension. Studies done in specific populations in Cameroon have revealed prevalence rates as high as 37.8% [5] and 57.3% in an elderly population [6]. It is projected that by 2025, 31.9% of Cameroonians (approximately 5.6 million people) will be living with hypertension [7]
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