Insights into Antihypertensive Medication Adherence: A Tertiary Care Teaching Hospital Study on Patient Compliance and Influencing Factors

Sudhanshu Shukla; Neeraj Hiremath; Arnab Sarkar; Atharv Mirajkar; Jayasheela Siddhalingayya Hiremath; Sanatkumar Bharamu Nyamagoud; Agadi Hiremath Vishwanatha Swamy

doi:10.5530/ijpi.14.2.63

Article

Insights into Antihypertensive Medication Adherence: A Tertiary Care Teaching Hospital Study on Patient Compliance and Influencing Factors

¹, ¹, ¹, ¹, ¹^★, ¹, ¹★ Corresponding author

¹Department of Pharmacy Practice, KLE College of Pharmacy (A Constituent Unit of KLE Academy of Higher Education and Research, Belagavi), Vidyanagar, Hubballi, Karnataka, INDIA.

CORRESPONDENCE

Jayasheela Siddhalingayya Hiremath

Department of Pharmacy Practice, KLE College of Pharmacy (A Constituent Unit of KLE Academy of Higher Education and Research, Belagavi), Vidyanagar, Hubballi, Karnataka, INDIA.

jayashiremath24@gmail.com

Received: 10-12-2023; Revised: 19-01-2024; Accepted: 28-02-2024.

Volume 14, Issue 2 · pp. 525-530 · 2024 · DOI: 10.5530/ijpi.14.2.63

ABSTRACT

Background: Hypertension is a chronic long-stay disease that requires proper treatment management and regular medication assessment, which ensure that the disease does not progress into a disorder. Medication Adherence is an easy access and assessable tool that provides insights about patient compliance to medications and effectiveness of therapy. This helps the physicians to improve patient treatment outcomes and quality of life by addressing the factors that influence medication adherence.Objectives: To assess patient compliance to antihypertensive medications and factors that influence medication adherence.Materials and Methods: A prospective Observational study was conducted in a tertiary care teaching hospital in Hubli among 200 hypertensive patients, the study subjects were selected based on inclusion and exclusion criteria, data was collected and sorted from patient data collection forms. Medication adherence rating scale was used to assess medication adherence among patients. The association between variables such as age, social status, co-morbidities and polypharmacy with medication adherence was determined using Pearson chi-square in SPSS version 25.Results: Our study included 200 hypertensive patients, most of them were males 64%. On assessing Medication adherence rating scale, we found that majority 62.8% of the study subjects adhere to their antihypertensive medication. The association between various factors that influence medication adherence was determined by Pearson Chi-square, we observed that age, social status, co-morbidities and polypharmacy were statistically significant at p=Conclusion: Medication adherence plays a significant role in assessing the patient’s response to a treatment and improving their quality of life. Similarly, our study highlights the importance of assessing medication adherence, especially in study subjects with existing co-morbidities and polypharmacy, thus reducing hospital stays and unnecessary side effects.

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INTRODUCTION

Chronically high blood pressure, defined as a systolic blood pressure greater than 140 mmHg and a diastolic blood pressure greater than 90 mmHg, is a major cause of morbidity and mortality that can result in stroke, myocardial infarction, congestive heart failure, and blindness. Every year 9.4 million people worldwide die as a result of hypertension or its complications. In India, the estimated prevalence of hypertension is 29% overall. Hypertension is responsible for 57% of all stroke deaths and 24% of all coronary event deaths.^1-4

Hypertension management at the population level is not optimum, despite the availability of evidence-based treatment guidelines and effective medical therapy.⁵Adherence is a key associated with the effectiveness of the treatment and is of greater importance in medications prescribed for chronic conditions.⁶ Numerous factors, such as complicated drug regimens, convenience considerations (like dosage frequency), behavioural factors, and challenges with treating asymptomatic diseases (like side effects) can all be barriers to medication adherence.⁷ A significant modifiable patient-related barrier is improving patient adherence to medicines in order to achieve controlled blood pressure.⁸ Studies have shown that anti-hypertensive lowers the risk of myocardial infarction and stroke by 15 and 30-45% respectively and that inadequate medication compliance may lead to less-than-ideal illness management and control, also leading to a decline in quality of life, wastage of medical resources, all of which might place a strain on the healthcare system.⁹

Medication Adherence can be measured directly by assaying for parent drug or its metabolites in blood or urine and indirectly through scaled questionnaires though less accurate but after validation these questionnaires are reliably credible.¹⁰ Adherence to antihypertensive medication can be influenced by the presence of comorbidities, or the coexistence of other medical conditions. It is important for healthcare providers to consider comorbidities and their potential impact on medication adherence when managing patients with hypertension and other medical problems.¹¹

Improving medication adherence can lead to better health outcomes, lower healthcare costs and improved quality of life for patients. Healthcare providers should prioritize addressing medication adherence with their patients and consider implementing evidence-based interventions to improve adherence.¹² Hence research about adherence-associated elements appears necessary.

MATERIALS AND METHODS

A prospective Observational study was conducted among 200 Hypertensive patients at a Tertiary Care Teaching Hospital in Hubli, for a period of one year. Study subjects were selected based on inclusion and exclusion criteria.

Inclusion Criteria

Subjects above 18 years of age, subjects with a known case of hypertension, Hypertensive subjects with co-morbidities, Subjects who are willing to participate, Subjects of either gender.

Exclusion Criteria

Subjects newly diagnosed with hypertension, Subjects who are attending out-patient department, Subjects who are not willing to participate, Subjects without complete case profile.

Data Analysis

Data was collected and sorted from patient data collection forms. MARS scale was used to assess medication adherence among patients. The association between variables such as age, social status, co-morbidities and polypharmacy with medication adherence was determined using Pearson chi-square in SPSS version 25.

RESULTS

Our study involved 200 hypertensive patients, most of them were males 64% compared to females 36% with a social status of 16% alcoholics and 7% smokers. The mean age of the study subjects was 61.47+12.97(as shown in Table 1). Duration of hypertension is a significant factor for determining the disease progression. Prescribing patterns of medication are influenced by the duration of disease. In our analysis, duration of hypertension was found to be around 1-5% in both male (61.03%) and female (38.8%).

In relation with co-morbidities, we observed that hypertension has a significant impact on the Cardiovascular system (CVS) and Central Nervous System (CNS), contributing to neurological disorders in 38.5% of cases and CVS 30.5% out which 63.9% had ischemic heart disease, endocrine disorders in 31.5%, respiratory disease 14.5%, hepatic disease 2% and other disorders including anemia and rheumatoid arthritis in less than 5% of cases (as shown in Table 2).

In our research, 62.8% of the participants showed high adherence and 15% showed low adherence. It was found that older adults 41.6% (81-90 years) failed to take their medications as prescribed (as shown in Table 3).

On determining the association between social status, age, gender, co-morbidities and polypharmacy with medication adherence, from our study we found that adherence to antihypertensive medications is significantly associated with social status both smoking [²(3,N=200)=187.0, p=.000)] and alcohol consumption [²(6, N=200)=189.37, p=.000)]; Age [²(78, N=200)=104.126, p=.026)], increasing age as factor for low adherence and polypharmacy [²(22, N=200)=248.00, p=.000)],that an increase in pill count decreases adherence. These factors were statistically significant on applying Pearson chi-square at p =<0.005 (Table 4). Whereas as adherence to medication is irrespective of gender.

We studied the impact of various disorders (comorbidities) on medication adherence, it was found that occurrence of cardiovascular events was associated with non-compliance to hypertensive medication, this association was statistically significant at [²(2, N=124)=12.05, p=.002)] whereas Renal disorders, Endocrine disorders, Respiratory disorders and Hepatic disorders were not statistically associated with medication adherence as shown in Table 4.

Table 1 Demographic details of the study population.

Sl. No.	Demographic details	Frequency (n)	Percentage	Total
Gender
1.	Male	127	64%	200
2.	Female	73	36%
Age
3.	21-30	1	0.5%	200
4.	31-40	10	5%
5.	41-50	33	16.5%
6.	51-60	31	15.5%
7.	61-70	61	30.5%
8.	71-80	52	26%
9.	81-90	12	6%
Social Status
10.	Alcoholic	32	16%	200
11.	Smokers	14	7%
Duration of Hypertension
Male
12.	Less than 1 year	25	64.1%	127
13.	1-5 years	47	61.03%
14.	6-10 years	25	58.13%
15.	11-15 years	5	83.3%
16.	More than 15 years	2	28.5%
Female
17.	Less than 1 year	14	35.89%	73
18.	1-5 years	30	38.8%
19.	6-10 years	18	41.86%
20.	11-15 years	1	16.6%
21.	More than 15 years	5	71.4%

Table 2 Comorbidities.

Sl. No.	Comorbidities	Total
Cardiovascular disease
1.	Ischemic heart disease	39	63.9%	61 (30.5%)
2.	Congested cardiac failure	3	4.91%
3.	Dilated cardiomyopathy	1	1.63%
4.	Left ventricular disfunction	18	29.50%
Endocrine disease
5.	Diabetes mellitus	52	26%	63 (31.5%)
6.	Diabetic retinopathy	2	1%
7.	Hypothyroidism	8	4%
8.	Diabetic ketoacidosis	1	0.5%
Respiratory disease
9.	Bronchopneumonia	9	4.5%	29 (14.5%)
10.	Chronic respiratory failure	2	1%
11.	Chronic obstructive pulmonary disease	13	6.5%
12.	Asthma	3	1.5%
13.	Upper respiratory tract infection	1	0.5%
14.	Tuberculosis	1	0.5%
Hepatic disease
15.	Hepatitis	2	50%	4 (2%)
16.	Chronic liver disease	1	25%
17.	Alcoholic liver disease	1	25%
Renal disease
18.	Chronic kidney disease	13	6.5%	27 (13.5%)
19.	Urinary tract infection	7	3.5%
20.	Acute kidney injury	7	3.5%
Neurological disease
21.	Epilepsy	11	5.5%	77 (38.5%)
22.	Cerebrovascular disease	55	27.5%
23.	Parkinson’s disease	2	0.5%
24.	Trigeminal neuralgia	2	0.5%
25.	Alcohol withdrawal syndrome	2	0.5%
26.	Alcohol dependent syndrome	5	2.5%
Other disease
27.	Anaemia	10	5%	36 (18%)
28.	Gastritis	12	6%
29.	Rheumatoid arthritis	3	1.5%
30.	Deep vein thrombosis	5	2.5%
31.	Acute diarrheal disease	6	3%

Table 3 Medication adherence among subjects.

Sl. No.	Variables	High adherence	Moderate adherence	Low adherence	Total
1.	Study population	125 (62.85%)	45(22.50%)	30(15%)	200
Gender
2.	Male	76(59.8%)	29(22.8%)	22(17.3%)	200
3.	Female	48(65.7%)	20(27.3%)	5(6.80%)
Age
4.	21-30	1(100%)	0	0	200
5.	31-40	9(90%)	1(10%)	0
6.	41-50	23(69.6%)	8(24.2%)	2(6.06%)
7.	51-60	21(67.7%)	6(19.8%)	4(12.9%)
8.	61-70	42(68.8%)	11(18%)	8(13.1%)
9.	71-80	27(51.9%)	12(23.9%)	13(25.0%)
10.	81-90	3(25.0%)	4(33.3%)	5(41.6%)
Comorbidities
11.	Cardiovascular disease	19(31.14%)	32(52.4%)	10(16.3%)	61
12.	Endocrine disease	26(41.2%)	27(42.8%)	10(15.8%)	63
13.	Respiratory disease	19(65.5%)	6(20.6%)	4(13.7%)	29
14.	Renal disease	13(48.1%)	11(40.7%)	3(11.1%)	27
15.	Hepatic disease	2(50%)	1(25%)	1(25%)	4

Table 4 Association of Variables with medication adherence.

Association of Demographics with medication adherence
Sl. No.	Variables	Value	D_f	significance (2-sided)
1.	Age with medication adherence Pearson Chi-Square	104.126	78	0.026*
2.	Gender with medication adherence Pearson Chi-Square	1.553	2	0.460
3.	Smoking with medication adherence Pearson Chi-Square	187.000	3	0.000*
4.	Alcohol with medication adherence Pearson Chi-Square	189.376	6	0.000*
	Association of various comorbidities with medication adherence
5.	cardiovascular disease with medication adherence Pearson Chi-Square	12.051	2	0.002*
6.	Endocrine disease with medication adherence Pearson Chi-Square	0.708	2	0.702
7.	Respiratory disease with medication adherence Pearson Chi-Square	9.077	2	0.011*
8.	Renal disease with medication adherence Pearson Chi-Square	1.926	2	0.382
9.	Hepatic disease with medication adherence Pearson Chi-Square	2.652	2	0.266
	Association of polypharmacy with medication adherence
10.	Polypharmacy with medication adherence Pearson Chi-Square	248.000	22	0.000*

DISCUSSION

Medication Adherence plays a significant role in management of chronic disorders, our research was conducted to assess medication adherence among in-patient subjects at tertiary care teaching hospital in Hubli. Our study showed a male predominance with 64%. the mean age group was 61.57±12.82 similar to the study conducted by Anuradha vp et al.,¹³ and Ajmal et al.,¹⁴ with 56.2% male dominance and subjects between 46-75 years of age respectively. In our analysis, duration of hypertension was found to be around 1-5 years in male (61.03%) and 6-10 years in female (38.8%) compared to the study conducted by Sharma A et al.,¹⁵ were the duration of hypertension in study subjects was less than 5 years in majority of the patients (57.3%).

Increasing age increases the risk of patients to acquire various co-morbidities and disorders, it also contributes to various changes in psychological behaviors making it difficult for the patient and physician to assure effective therapy, our study showed a statistical significance at p=<0.005 A study conducted by Ahmed et al.¹⁶ support the same.

Managing Co-morbidities with chronic illness is challenging in current scenario, our study showed that hypertension significantly affects both cardiovascular and cerebrovascular disorders, ischemic heart disease being most prevalent with 63.9% similar to the study conducted by Supratim datta et al.¹⁷ had shown showed that ischemic heart disease (27.2%), and renal parenchymal disease (20.2%) was prevalent.

A study conducted by Fatima Yousuf et al.¹⁸ showed that most of their study subjects were non- compliant to their anti-hypertensive therapy, in comparison to our study subjects were in a large number 62.85% showed high adherence.

On assessing Statistical significance using Pearson chi-square, we found that social status, age, co-morbidities and polypharmacy were significant at p=<0.005 similarly a study conducted by Solomon et al,¹⁹ concluded that patients with co-morbidities and consuming alcohol showed low adherence when compared to patients without co-morbidities.

Polypharmacy is a factor to be considered by physicians while treating chronic illness as an increase in pill counts results in patient non-compliance to medications, our study showed that polypharmacy is statistically associated with medication adherence at p=<0.005 which is similar to the study conducted by Niteesh et al,²⁰ concluded that polypharmacy reduces medication adherence.

CONCLUSION

Chronic disease such as Hypertension requires long term treatment management and frequent check-up and medication assessments. Choice of treatment and their effectiveness can be assessed without major complications using scales of medication adherence. Medication adherence thus plays a significant role in assessing the patient’s response to a treatment and improvement in their quality of life.

Our study highlights the importance of assessing medication adherence, especially in study subjects with existing comorbidities and polypharmacy. This reduces hospital admission and stay and also ensures that unnecessary side effects are addressed on time and the right treatment is being provided. Further studies on this topic conducted in larger sample size would give us detailed insights about how medication adherence influence or improve a patient’s quality of life.

Acknowledgement

We would like to express sincere thanks to the Management and Principal, KLE College of Pharmacy, Hubballi, Karnataka for providing necessary facilities to carry out research.

We owe our hearty thanks to Dr. Abhishek B J, Dr. Santosh B Patil and Dr. Girish Hampannavar faculties of KLE College of pharmacy for their timely help and support during the course.

Conflict of Interest

The authors declare that there is no conflict of interest.

Ethics Statement

Informed Consent Form was taken from the participants.

REFERENCES

As published

Showing references and in-text citations exactly as published.

Anchala, R, Kannuri, N, Pant, H, Khan, H, Franco, O, Angelantonio, D, & E. (2014). Hypertension in India: A systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens, 32, 1170–7.GOOGLE SCHOLAR
Asgedom, S, Atey, T, & Desse, T. (2018). Antihypertensive medication adherence and associated factors among adult hypertensive patients at jimma university specialized Hospital, southwest ethiopia. BMC Res Notes [internet], 11(1). https://doi.org/10.1186/s13104-018-3139-GOOGLE SCHOLAR
Borzecki, A, Oliveria, S, & Berlowitz, D. (2005). Barriers to hypertension control. Am Heart J, 149, 785–94.GOOGLE SCHOLAR
Chaudri, N. (2004). Adherence to long-term therapies evidence for action world health organization (WHO). 2003, 216 pages [English]. ISBN 92 4 154599 2. Ann Saudi Med [Internet], 24(3), 221-2. 5144/0256-4947.22. http://dx.doi.org/10GOOGLE SCHOLAR
Choudhry, N, Kronish, I, Vongpatanasin, W, Ferdinand, K, Pavlik, V, & Egan, B. (2022). Medication adherence and blood pressure control: A scientific statement from the american heart association. Hypertension [internet], 79(1). Http ://dx.doi.org/. https://doi.org/10.1161/hyp.0000000000000203 GOOGLE SCHOLAR
Datta, S. (2017). Utilization study of antihypertensives in a south indian tertiary care teaching hospital and adherence to standard treatment guidelines. Journal of Basic and Clinical Pharmacy, 8(1), 33.GOOGLE SCHOLAR
Dusing, R. (2006). Overcoming barriers to effective blood pressure control in patients with hypertension. Curr Med Res Opin, 22(8), 1545–53.GOOGLE SCHOLAR
Gupta, R, & Gupta, V. (2009). Hypertension epidemiology in India: Lessons from jaipur heart watch. Curr Sci, 97, 349–55.GOOGLE SCHOLAR
Ho, P, Bryson, C, & Rumsfeld, J. (2009). Medication adherence: Its importance in cardiovascular outcomes. Circulation, 119(23), 3028–3035.GOOGLE SCHOLAR
Hussein, A, Awad, M, & Mahmoud, H. (2020). Patient adherence to antihypertensive medications in upper Egypt: A cross-sectional study. Egypt Heart J [internet], 72(1). https://doi.org/10.1186/s43044-020-00066-GOOGLE SCHOLAR
Kokubo, Y, & Iwashima, Y. (2015). Higher blood pressure as a risk factor for diseases other than stroke and ischemic heart disease. Hypertension, 66(2), 254–9. ERTENSIONAHA.115.03480. https://doi.org/10.1161/HYP GOOGLE SCHOLAR
Mankadavath, A, Chandrasekhar, D, Thomas, T, Zuhra, F, Kaipanthodi, S, & Parambil, J. (2014). A prospective drug use evaluation of antihypertensive drugs in in-patients of a tertiary referral care hospital. Journal of Basic and Clinical Physiology and Pharmacology, 0(0).GOOGLE SCHOLAR
Osterberg, L, & Blaschke, T. (2005). Adherence to medication. N Engl J Med, 353, 487–97.GOOGLE SCHOLAR
Saadat, Z, Nikdoust, F, Aerab-Sheibani, H, Bahremand, M, Shobeiri, E, & Saadat, H. (2015). Adherence to antihypertensives in patients with comorbid condition. Nephrourol Mon [internet], 7(4), 6. https://doi.org/10.5812/numonthly.298 GOOGLE SCHOLAR
Sarkodie, E, Afriyie, K, D, Hutton-Nyameaye, A, Amponsah, K, & S (2020). Adherence to drug therapy among hypertensive patients attending two district hospitals in ghana. Afr Health Sci [internet], 20(3), 1355–67. jol.info/index.php/ahs/article/view/20034. https://www.aGOOGLE SCHOLAR
Sharma, A. (2018). Drug utilization study on hypertensive patients and assessment of medication adherence to jnc-8 guidelines in north indian tertiary care hospital: A cross-sectional study. Adv Res Gastroenterol Hepatol, 9(1). Http ://dx.doi.org/. https://doi.org/10.19080/argh.2018.09.55575 GOOGLE SCHOLAR
Tackmann, E, & Dettmer, S. (2018). Health-related quality of life in adult heart-transplant recipients—a systematic review. Herz, 45(5), 475–82.GOOGLE SCHOLAR
Vp, A, & Sruthy, S. (2021). Drug utilization pattern of antihypertensive medications in a tertiary care hospital, south india. Asian J Pharm Clin Res.GOOGLE SCHOLAR
W.H.O report on global prevalence of hypertension published on world health day. (2013). _DCO_WHD_2013.2_eng.pdf;jsessionid=F638668E0D914847E4B72CCAFB90BC63?s Equence=1. Accessed July, 27, 201. https://apps.who.int/iris/bitstream/handle/10665/79059/WHOGOOGLE SCHOLAR
Yousuf, F, Khan, M, Bibi, R, Arif, A, Arshad, A, & Almas, A. (2023). Medication adherence in patients with uncontrolled hypertension & hypertensive crisis presenting to a hospital setting in Karachi, pakistan. Cureus, 15(1), e33995. https://doi.org/10.7759/cureus.33995 GOOGLE SCHOLAR

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DOI10.5530/ijpi.14.2.63

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Shukla, S., Hiremath, N., Sarkar, A., Mirajkar, A., Hiremath, J. S., Nyamagoud, S. B., & Swamy, A. H. V. (2024). Insights into Antihypertensive Medication Adherence: A Tertiary Care Teaching Hospital Study on Patient Compliance and Influencing Factors. International Journal of Pharmaceutical Investigation, 14(2), 525-530. https://doi.org/10.5530/ijpi.14.2.63

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[ref-3] Anchala, R, Kannuri, N, Pant, H, Khan, H, Franco, O, Angelantonio, D, & E. (2014). Hypertension in India: A systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens, 32, 1170–7.GOOGLE SCHOLAR

[ref-19] Asgedom, S, Atey, T, & Desse, T. (2018). Antihypertensive medication adherence and associated factors among adult hypertensive patients at jimma university specialized Hospital, southwest ethiopia. BMC Res Notes [internet], 11(1). https://doi.org/10.1186/s13104-018-3139-GOOGLE SCHOLAR

[ref-8] Borzecki, A, Oliveria, S, & Berlowitz, D. (2005). Barriers to hypertension control. Am Heart J, 149, 785–94.GOOGLE SCHOLAR

[ref-9] Chaudri, N. (2004). Adherence to long-term therapies evidence for action world health organization (WHO). 2003, 216 pages [English]. ISBN 92 4 154599 2. Ann Saudi Med [Internet], 24(3), 221-2. 5144/0256-4947.22. http://dx.doi.org/10GOOGLE SCHOLAR

[ref-20] Choudhry, N, Kronish, I, Vongpatanasin, W, Ferdinand, K, Pavlik, V, & Egan, B. (2022). Medication adherence and blood pressure control: A scientific statement from the american heart association. Hypertension [internet], 79(1). Http ://dx.doi.org/. https://doi.org/10.1161/hyp.0000000000000203 GOOGLE SCHOLAR

[ref-17] Datta, S. (2017). Utilization study of antihypertensives in a south indian tertiary care teaching hospital and adherence to standard treatment guidelines. Journal of Basic and Clinical Pharmacy, 8(1), 33.GOOGLE SCHOLAR

[ref-5] Dusing, R. (2006). Overcoming barriers to effective blood pressure control in patients with hypertension. Curr Med Res Opin, 22(8), 1545–53.GOOGLE SCHOLAR

[ref-4] Gupta, R, & Gupta, V. (2009). Hypertension epidemiology in India: Lessons from jaipur heart watch. Curr Sci, 97, 349–55.GOOGLE SCHOLAR

[ref-12] Ho, P, Bryson, C, & Rumsfeld, J. (2009). Medication adherence: Its importance in cardiovascular outcomes. Circulation, 119(23), 3028–3035.GOOGLE SCHOLAR

[ref-16] Hussein, A, Awad, M, & Mahmoud, H. (2020). Patient adherence to antihypertensive medications in upper Egypt: A cross-sectional study. Egypt Heart J [internet], 72(1). https://doi.org/10.1186/s43044-020-00066-GOOGLE SCHOLAR

[ref-1] Kokubo, Y, & Iwashima, Y. (2015). Higher blood pressure as a risk factor for diseases other than stroke and ischemic heart disease. Hypertension, 66(2), 254–9. ERTENSIONAHA.115.03480. https://doi.org/10.1161/HYP GOOGLE SCHOLAR

[ref-14] Mankadavath, A, Chandrasekhar, D, Thomas, T, Zuhra, F, Kaipanthodi, S, & Parambil, J. (2014). A prospective drug use evaluation of antihypertensive drugs in in-patients of a tertiary referral care hospital. Journal of Basic and Clinical Physiology and Pharmacology, 0(0).GOOGLE SCHOLAR

[ref-7] Osterberg, L, & Blaschke, T. (2005). Adherence to medication. N Engl J Med, 353, 487–97.GOOGLE SCHOLAR

[ref-11] Saadat, Z, Nikdoust, F, Aerab-Sheibani, H, Bahremand, M, Shobeiri, E, & Saadat, H. (2015). Adherence to antihypertensives in patients with comorbid condition. Nephrourol Mon [internet], 7(4), 6. https://doi.org/10.5812/numonthly.298 GOOGLE SCHOLAR

[ref-10] Sarkodie, E, Afriyie, K, D, Hutton-Nyameaye, A, Amponsah, K, & S (2020). Adherence to drug therapy among hypertensive patients attending two district hospitals in ghana. Afr Health Sci [internet], 20(3), 1355–67. jol.info/index.php/ahs/article/view/20034. https://www.aGOOGLE SCHOLAR

[ref-15] Sharma, A. (2018). Drug utilization study on hypertensive patients and assessment of medication adherence to jnc-8 guidelines in north indian tertiary care hospital: A cross-sectional study. Adv Res Gastroenterol Hepatol, 9(1). Http ://dx.doi.org/. https://doi.org/10.19080/argh.2018.09.55575 GOOGLE SCHOLAR

[ref-6] Tackmann, E, & Dettmer, S. (2018). Health-related quality of life in adult heart-transplant recipients—a systematic review. Herz, 45(5), 475–82.GOOGLE SCHOLAR

[ref-13] Vp, A, & Sruthy, S. (2021). Drug utilization pattern of antihypertensive medications in a tertiary care hospital, south india. Asian J Pharm Clin Res.GOOGLE SCHOLAR

[ref-2] W.H.O report on global prevalence of hypertension published on world health day. (2013). _DCO_WHD_2013.2_eng.pdf;jsessionid=F638668E0D914847E4B72CCAFB90BC63?s Equence=1. Accessed July, 27, 201. https://apps.who.int/iris/bitstream/handle/10665/79059/WHOGOOGLE SCHOLAR

[ref-18] Yousuf, F, Khan, M, Bibi, R, Arif, A, Arshad, A, & Almas, A. (2023). Medication adherence in patients with uncontrolled hypertension & hypertensive crisis presenting to a hospital setting in Karachi, pakistan. Cureus, 15(1), e33995. https://doi.org/10.7759/cureus.33995 GOOGLE SCHOLAR

Insights into Antihypertensive Medication Adherence: A Tertiary Care Teaching Hospital Study on Patient Compliance and Influencing Factors

ABSTRACT

KEYWORDS

FULL TEXT

INTRODUCTION

MATERIALS AND METHODS

Inclusion Criteria

Exclusion Criteria

Data Analysis

RESULTS

DISCUSSION

CONCLUSION

Acknowledgement

Conflict of Interest

Ethics Statement

REFERENCES

Cite this article

Copyright and licence

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