Poor adherence to medication and salt restriction as a barrier to reaching blood pressure control in patients with hypertension: Cross-sectional study from 12 sub-Saharan countries

Diane Macquart de Terline; Kouadio Euloge Kramoh; Ibrahima Bara Diop; Carol Nhavoto; Dadhi M Balde; Beatriz Ferreira; Martin Dèdonougbo Houenassi; Dominique Hounsou; Méo Stéphane Ikama; Adama Kane; Suzy Gisèle Kimbally-Kaki; Samuel Kingue; Florent Koffi; Charles Kouam Kouam; Emmanuel Limbole; Liliane Mfeukeu Kuate; Jean Bruno Mipinda; Yves N'goran; Zouwera Sesso; Abdallahi Sidi Aly; Ibrahim Ali Toure; Pierre François Plouin; Michel Azizi; Marie Cécile Perier; Kumar Narayanan; Jean Philippe Empana; Xavier Jouven; Marie Antignac

doi:10.1016/j.acvd.2019.11.009

Poor adherence to medication and salt restriction as a barrier to reaching blood pressure control in patients with hypertension: Cross-sectional study from 12 sub-Saharan countries

Arch Cardiovasc Dis. 2020 Jun-Jul;113(6-7):433-442. doi: 10.1016/j.acvd.2019.11.009. Epub 2020 May 17.

Authors

Diane Macquart de Terline¹, Kouadio Euloge Kramoh², Ibrahima Bara Diop³, Carol Nhavoto⁴, Dadhi M Balde⁵, Beatriz Ferreira⁴, Martin Dèdonougbo Houenassi⁶, Dominique Hounsou⁶, Méo Stéphane Ikama⁷, Adama Kane⁸, Suzy Gisèle Kimbally-Kaki⁷, Samuel Kingue⁹, Florent Koffi², Charles Kouam Kouam¹⁰, Emmanuel Limbole¹¹, Liliane Mfeukeu Kuate¹², Jean Bruno Mipinda¹³, Yves N'goran², Zouwera Sesso¹⁴, Abdallahi Sidi Aly¹⁵, Ibrahim Ali Toure¹⁶, Pierre François Plouin¹⁷, Michel Azizi¹⁷, Marie Cécile Perier¹⁸, Kumar Narayanan¹⁹, Jean Philippe Empana¹⁸, Xavier Jouven¹⁷, Marie Antignac²⁰

Affiliations

¹ Sorbonne Université, AP-HP, Sorbonne Université, Hôpital Saint Antoine, Service de Pharmacie, 75012 Paris, France; Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France; Université de Paris, Paris, France. Electronic address: diane.macquart-de-terline@aphp.fr.
² Institute of Cardiology of Abidjan, BPV 206, Abidjan, Côte d'Ivoire.
³ Cardiology Department, University Hospital of Fann, Dakar, Senegal.
⁴ Instituto do Coração (ICOR), Maputo, Mozambique.
⁵ Department of Cardiology, University Hospital of Conakry, Guinea.
⁶ National University Hospital of Hubert K. Maga (CNHU-HKM), 01 BP 386, Cotonou, Bénin.
⁷ Cardiology Department, National University Hospital of Brazzaville, Marien Ngouabi University, Brazzaville, Congo.
⁸ Cardiology Department, University Hospital of Aristide Le Dantec, Dakar, Senegal.
⁹ University of Yaoundé, Ministry of Public Health, Cameroon.
¹⁰ Internal Medicine Department, Regional Hospital, Bafoussam, Cameroon.
¹¹ Department of Internal Medicine of la Gombe (CMCG), Ngaliema Hospital, Kinshasa, Democratic Republic of the Congo.
¹² Central Hospital of Yaoundé, Cameroon.
¹³ University Hospital of Libreville, Libreville, Gabon.
¹⁴ Cardiology Department, Lomé, Togo.
¹⁵ Cardiology Clinics, Nouakchott, Mauritania.
¹⁶ Internal Medicine and Cardiology Department, University Hospital of Lamordé, Niamey University, Niamey, Niger.
¹⁷ Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France; Université de Paris, Paris, France; Department of Cardiology, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France.
¹⁸ Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France.
¹⁹ MaxCure Hospitals, Hyderabad, Telangana, 500081 India.
²⁰ Sorbonne Université, AP-HP, Sorbonne Université, Hôpital Saint Antoine, Service de Pharmacie, 75012 Paris, France; Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France.

PMID: 32434710
DOI: 10.1016/j.acvd.2019.11.009

Abstract

Background: Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and diet are the cornerstone of effective hypertension control.

Aims: To assess adherence to medication and salt restriction in 12 sub-Saharan countries, and to study the relationship between adherence and blood pressure control in patients with hypertension.

Methods: We conducted a cross-sectional survey in urban clinics in twelve sub-Saharan countries. Data were collected on demographics, treatment and adequacy of blood pressure control in patients with hypertension attending the clinics. Adherence was assessed by questionnaires completed by the patients. Hypertension grades were defined according to European Society of Cardiology guidelines. Association between adherence and blood pressure control was investigated using multilevel logistic regression analysis, adjusting for age, sex and country.

Results: Among the 2198 patients, 77.4% had uncontrolled blood pressure, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% were poorly adherent to both. Poor adherence to salt restriction (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.03-1.72), medication (OR 1.56, 95% CI 1.25-1.93) or both (OR 1.91 1.39-2.66) was related to uncontrolled blood pressure. Moreover, poor adherence to both medication and salt restriction was related to a 1.52-fold (95% CI 1.04-2.22), 1.8-fold (95% CI 1.22-2.65) and 3.08-fold (95% CI 2.02-4.69) increased likelihood of hypertension grade 1, 2 and 3, respectively.

Conclusions: High levels of poor adherence to salt restriction and medication were noted in this urban sub-Saharan study; both were significantly associated with uncontrolled blood pressure, representing major opportunities for intervention to improve hypertension control in sub-Saharan Africa.

Keywords: Adhérence; Afrique Subsaharienne; Epidemiology; Global health; Hypertension; Medication adherence; Sub-Saharan Africa; Épidémiologie.

Publication types

Multicenter Study
Observational Study

MeSH terms

Africa South of the Sahara / epidemiology
Aged
Antihypertensive Agents / therapeutic use*
Black People
Blood Pressure / drug effects*
Cross-Sectional Studies
Diet, Sodium-Restricted* / ethnology
Female
Health Care Surveys
Health Knowledge, Attitudes, Practice / ethnology
Humans
Hypertension / diagnosis
Hypertension / ethnology
Hypertension / physiopathology
Hypertension / therapy*
Male
Medication Adherence / ethnology*
Middle Aged
Risk Factors
Risk Reduction Behavior*
Treatment Outcome

Substances

Antihypertensive Agents