NON-COMPLIANCE TO ANTI-HYPERTENSIVE MEDICATION AND ITS ASSOCIATED FACTORS AMONG HYPERTENSIVES
Abstract
Background: Non-compliance to anti-hypertensive drugs can have negative impact on cardiovascular outcome. Various studies have been conducted on the issue but the factors are not yet explored properly, particularly in Pakistan. This study was conducted to determine the frequency and factors associated with non-compliance to anti-hypertensive medications in Karachi. Methods: This descriptive cross sectional study was conducted on 113 indoor hypertensive patients included by purposive sampling, aged 30 years and above diagnosed at least 6 months back in public sector tertiary care institutes of Karachi from March to October 2011. Data was collected through a questionnaire in Urdu. Demographic data, hypertension diagnosis, medical co-morbidity, current number of anti-hypertensive medicines, frequency of missing prescribed antihypertensive therapy and other factors affecting compliance pertaining to medicines, patient, physician and health care centre were included in the questionnaire. Results: This study revealed that 68.14% patients were non-compliant. Non-compliance was found to be associated with gender and socioeconomic status. Duration of hypertension, duration between follow up visits to physician, number of drugs, careless attitude, role of physician and limiting access to health care center are found to be important factors in non-compliance. Conclusions: Multiple factors including patients, medicine and health care system related, which can be prevented with simple measures, were found responsible for higher prevalence of non-compliance against anti-hypertensive medicines.Keywords: Non-compliance, antihypertensive drugs, risk factors for non-compliance, tertiary care hospital.References
Hadi N, Rostami-Gooran GN. Determinant factors of medication compliance in hypertensive patients of Shiraz, Iran. Arch Iranian Med 2004;7(4):292–6.
Health Stats International, hypertension statistics, worldwide. [Online]; [cited on April 19, 2011] Available from :http://www.healthstats.com/en/hypertension-statistics.html
WHO. Global Health Observatory, non communicable disease, risk factors, blood pressure prevalence. [online]. 2014; [cited2014 July 22]. Available from: http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/
Centres for disease control and prevention. High blood pressure facts; high blood pressure in the United States. [Online]. 2014; [cited 2014 July 22] Available from: http://www.cdc.gov/bloodpressure/facts.htm
WHO. Non communicable diseases, hypertension.[Internet]. [cited2011april12]; Available from: http://www.emro.who.int/ncd/hypertension.html
American heart association. Available from: https://www.heart.org/idc/groups/heart-public/ .../ucm_319587.pdf
Ahmad k. Facing up to Pakistan's cardiovascular challenge. Lancet 2002;259(9309):859.
Ross S, Walker A, MacLeod MJ. Patient compliance in hypertension: role of illness perceptions and treatment beliefs. J Hum Hypertens 2004;18(19):607–13.
Ikeda N, Sapienza D , Guerrero R , Aekplakorn W , Naghavi M , Mokdad AH, et al. Control of hypertension with medication: a comparative analysis of national surveys in 20 countries. Bull World Health Organ 2014;92(1):10–19.
Almas A, Hameed A, Ahmed B, Islam M. Compliance to antihypertensive therapy. J Coll Physicians Surg Pak 2006;16(1):23–6.
Niaz SA. Blood Pressure Control, follow-up and Drug Compliance among Hypertensive patients at Civil Hospital, Karachi. Med Channel 1999;5(1):5–10.
Mant J, McManus RJ. Does it matter whether patients take their antihypertensive medication as prescribed? The complex relationship between adherence and blood pressure control. J Hum Hypertens 2006;20(8):551–3.
Gregoire J, Moisan J, Guibert R, Ciampi A, Milot A. Predictors of self-reported noncompliance with anti-hypertensive drug treatment:prospective cohort study. Can J Cardiol 2006;22(4):323–9.
Thrall G, Lip GY, Lane D. Compliance with pharmacological therapy in hypertension: can we do better and how?, J Hum Hypertens 2004;18(9)595–7.
Ahmed N, Abdul Khaliq M, Shah SH, Anwar W. Compliance to anti-hypertensive drugs, salt restriction, exercise and control of systemic hypertension in hypertensive patients at Abbottabad. J Ayub Med Coll Abbottabad 2008;20(2):66–9.
Joho AA. Factors Affecting Treatment Compliance Among Hypertension Patients in three District Hospitals - Dar es Salaam. Masters thesis, MuhimbiliUniversity of Health and Allied Sciences. [Online]. 2012 [cited on 2014 July 22]; Availablefrom:http://ir.muhas.ac.tz:8080/jspui/bitstream/123456789/590/1/Angelina%20Joho%20Final%20dissertation.pdf
Cohen JS. Adverse drug effects, compliance and initial doses of antihypertensive drugs recommended by the joint national committee Vs the physician’s desk reference. Arch Intern Med 2001;161(6):880–5.
Mac ConnachIe AM. MacleanD. Low dose combination anti-hypertensive therapy: additional efficacy without additional adverse effects? Drug safety 1995;12(2):85–90.
Flack JM, Yunis C, Preisser J, Holmes CB, Mensah G, McLean B, et al. The rapidity of drug dose escalation influences blood pressure response and adverse effects and burden in patients with hypertension: the Quinapril Titration Interval Management Evaluation (ATIME) Study. Arch Intern Med 2000;160:1842–7.
Almas A, Godil SS, Lalani S, Samani ZA, Khan AH. Good knowledge about hypertension is linked to better control of hypertension; A multicentre cross sectional study in Karachi, Pakistan. BMC Res Notes 2012;5:579.
Sanson-Fisher RW, Clover K. Compliance in the treatment of hypertension: a need for action. Am J Hypertens. 1995;8(10 Pt 2):82S-88S.
Elzubier AG, Husain AA., Suleiman IA., Hamid ZA. Drug compliance among hypertensive patients in Kassala, eastern Sudan. East Mediterr Health J 2000;6(1):100–5.
Christian L. Out-of-pocket household health expenditures and their use in National Health Accounts: Evidence from Pakistan. [cited on March 13, 2014]. Available from: http://www.academia.edu/5929712
Hadi N, Rostami-Gooran GN. Determinant factors of medication compliance in hypertensive patients of Shiraz, Iran. Arch Iranian Med 2004;7(4):292–6.
Health Stats International, hypertension statistics, worldwide. [Online]; [cited on April 19, 2011] Available from :http://www.healthstats.com/en/hypertension-statistics.html
WHO. Global Health Observatory, non communicable disease, risk factors, blood pressure prevalence. [online]. 2014; [cited2014 July 22]. Available from: http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/
Centres for disease control and prevention. High blood pressure facts; high blood pressure in the United States. [Online]. 2014; [cited 2014 July 22] Available from: http://www.cdc.gov/bloodpressure/facts.htm
WHO. Non communicable diseases, hypertension.[Internet]. [cited2011april12]; Available from: http://www.emro.who.int/ncd/hypertension.html
American heart association. Available from: https://www.heart.org/idc/groups/heart-public/ .../ucm_319587.pdf
Ahmad k. Facing up to Pakistan's cardiovascular challenge. Lancet 2002;259(9309):859.
Ross S, Walker A, MacLeod MJ. Patient compliance in hypertension: role of illness perceptions and treatment beliefs. J Hum Hypertens 2004;18(19):607–13.
Ikeda N, Sapienza D , Guerrero R , Aekplakorn W , Naghavi M , Mokdad AH, et al. Control of hypertension with medication: a comparative analysis of national surveys in 20 countries. Bull World Health Organ 2014;92(1):10–19.
Almas A, Hameed A, Ahmed B, Islam M. Compliance to antihypertensive therapy. J Coll Physicians Surg Pak 2006;16(1):23–6.
Niaz SA. Blood Pressure Control, follow-up and Drug Compliance among Hypertensive patients at Civil Hospital, Karachi. Med Channel 1999;5(1):5–10.
Mant J, McManus RJ. Does it matter whether patients take their antihypertensive medication as prescribed? The complex relationship between adherence and blood pressure control. J Hum Hypertens 2006;20(8):551–3.
Gregoire J, Moisan J, Guibert R, Ciampi A, Milot A. Predictors of self-reported noncompliance with anti-hypertensive drug treatment:prospective cohort study. Can J Cardiol 2006;22(4):323–9.
Thrall G, Lip GY, Lane D. Compliance with pharmacological therapy in hypertension: can we do better and how?, J Hum Hypertens 2004;18(9)595–7.
Ahmed N, Abdul Khaliq M, Shah SH, Anwar W. Compliance to anti-hypertensive drugs, salt restriction, exercise and control of systemic hypertension in hypertensive patients at Abbottabad. J Ayub Med Coll Abbottabad 2008;20(2):66–9.
Joho AA. Factors Affecting Treatment Compliance Among Hypertension Patients in three District Hospitals - Dar es Salaam. Masters thesis, MuhimbiliUniversity of Health and Allied Sciences. [Online]. 2012 [cited on 2014 July 22]; Availablefrom:http://ir.muhas.ac.tz:8080/jspui/bitstream/123456789/590/1/Angelina%20Joho%20Final%20dissertation.pdf
Cohen JS. Adverse drug effects, compliance and initial doses of antihypertensive drugs recommended by the joint national committee Vs the physician’s desk reference. Arch Intern Med 2001;161(6):880–5.
Mac ConnachIe AM. MacleanD. Low dose combination anti-hypertensive therapy: additional efficacy without additional adverse effects? Drug safety 1995;12(2):85–90.
Flack JM, Yunis C, Preisser J, Holmes CB, Mensah G, McLean B, et al. The rapidity of drug dose escalation influences blood pressure response and adverse effects and burden in patients with hypertension: the Quinapril Titration Interval Management Evaluation (ATIME) Study. Arch Intern Med 2000;160:1842–7.
Almas A, Godil SS, Lalani S, Samani ZA, Khan AH. Good knowledge about hypertension is linked to better control of hypertension; A multicentre cross sectional study in Karachi, Pakistan. BMC Res Notes 2012;5:579.
Sanson-Fisher RW, Clover K. Compliance in the treatment of hypertension: a need for action. Am J Hypertens. 1995;8(10 Pt 2):82S-88S.
Elzubier AG, Husain AA., Suleiman IA., Hamid ZA. Drug compliance among hypertensive patients in Kassala, eastern Sudan. East Mediterr Health J 2000;6(1):100–5.
Christian L. Out-of-pocket household health expenditures and their use in National Health Accounts: Evidence from Pakistan. [cited on March 13, 2014]. Available from: http://www.academia.edu/5929712
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