Factors Associated with Antihypertensive Medication Non-Adherence: A Cross-Sectional Study Among Lebanese Hypertensive Adults

Hanine Abbas; Mazen Kurdi; Frank de Vries; Hein A W van Onzenoort; Johanna H M Driessen; Myriam Watfa; Rita Karam

doi:10.2147/PPA.S238751

Factors Associated with Antihypertensive Medication Non-Adherence: A Cross-Sectional Study Among Lebanese Hypertensive Adults

Patient Prefer Adherence. 2020 Apr 1:14:663-673. doi: 10.2147/PPA.S238751. eCollection 2020.

Authors

Hanine Abbas^{1

2

3}, Mazen Kurdi¹, Frank de Vries^{2

3

4}, Hein A W van Onzenoort^{2

5}, Johanna H M Driessen^{2

3

4

6}, Myriam Watfa⁷, Rita Karam^{1

7

8}

Affiliations

¹ Department of Chemistry and Biochemistry, Faculty of Sciences, Lebanese University, Beirut, Lebanon.
² Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
³ Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands.
⁴ Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, the Netherlands.
⁵ Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands.
⁶ NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands.
⁷ Quality Assurance of Pharmaceutical Products Department, Lebanese Ministry of Public Health, Beirut, Lebanon.
⁸ Pharmacology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.

Abstract

Background: Poor adherence to antihypertensives is associated with negative outcome of the disease as well as loss of health-care resources. Addressing the epidemic of poor adherence requires identifying factors associated with this behaviour. The aim of this study is to describe adherence to antihypertensive medication among Lebanese hypertensive patients and to evaluate the association between socio-economic, patient- and conditions-related factors and non-adherence.

Methods: A cross-sectional study was carried out on adherence to antihypertensive medications covering all governorates of Lebanon. This study was conducted between February 2018 and January 2019 on a random sample of 1497 hypertensive patients. A face-to-face questionnaire was used to assess adherence to antihypertensive medication and its determinants according to the five World Health Organization (WHO) main categories. Logistic regression analysis was performed to test the adjusted association between the multiple exposure factors, and drug adherence data were collected by trained interviewers.

Results: Adherence to antihypertensive medications was reported by 1253 (83.7%) of the patients. After multivariate analysis, patients who tried to control their stress level (OR = 0.77, 95% CI [0.38-0.95]), those who had normal BP readings (OR =0.49, 95% CI [0.18-0.97]), and those who believed in the effectiveness of their treatment (OR = 0.31, 95% CI [0.14-0.76]) had a significantly lower chance to exhibit non-adherence to their treatment. However, older patients (OR= 1.87, 95% CI [1.23-2.21]), divorced/separated patients (OR= 2.14, 95% CI [1.31-5.48]), married (OR=1.96, 95% CI [1.27-3.90]), widowed (OR=2.11, 95% CI [1.62-6.50]), obese patients (OR = 1.76, 95% CI [1.21-1.94]), and patients who smoked hookah and cigarettes (OR = 2.62, 95% CI [1.17-6.76]) were more likely to exhibit non-adherence.

Conclusion: Our study highlights the influence of factors such as old age, marital status, BMI and high level of emotional stress on non-adherence to medication in hypertensive patients. These determinants should be incorporated into adherence improving strategies.

Keywords: Lebanon; antihypertensive medications; condition-related factor; non-adherence; patient-related factors.