The adherence status of HTN patients to anti-hypertensive medications remains a major challenge for public health, especially in developing countries. Poor adherence to antihypertensive medication is the main reason for uncontrolled HTN, serious complications, and wastage of health care resources. Drug adherence is a crucial issue in the management of HTN diseases. As different studies show the major challenge in controlling BP is lack of persistence follow up with poor day to day execution of the prescribed drugs (14)
In this study, more than half (56.9%) of the respondents were found to be adherent to their antihypertensive medication treatment. This finding consistent with the study done in Kenya (62.4%) (22) and JUSH (61.7%)(30). The observed 56.9% is higher than the study reported in India (23.7%) (14), North Vitienema (49.8%) (18), Cameron (43.9%) (5) and Nedjo general hospital (3.14%) (23). The possible discrepancy might be explained, in the current study more than half (57.8%) of HTN patients receive free medical care and drugs, whereas, in the other study, patients pay for their treatment. In Nedjo general hospital small (172) sample size was used.
However the present finding is lower than the studies done in Romania (69.8%) (19), Sri Lanka (71.8% ) (20) and Korea (81.7%) (21), Debre tabor general hospital (75.1%) (12) and University of Gondar hospital (64.6%) (28). This inconsistency might be due to better health care and health facility, better knowledge toward HTN and its management among participants and socio-demographic variation in Romania, Sri Lanka, and Korea, as well as sample size variation (1,523) in Korea than the current study. In Debre tabor general hospital and University of Gondar hospital study, the adherence status was assessed using the MMAS-4.
In the current study, there is a significant association between marital status and antihypertensive MA. Those who got married were three times more adherent than widowed. This finding is in line with the study done in north United Arab Emirates, Ghana and Black Lion hospital (37, 42, 43). This association could be due to, those who married had a person to whom share their stressor as well as one can remind the others, the time to take their medication.
This study shows that, those who live in urban area were three times more adherent than the counterpart. This finding is consistent with a study done in Debra tabor general hospital and Hawass referral hospitals (12, 15). The association might be explained that urban residents lived to have a high chance to access media, too near the health facility, and took less time to reach the health facility for their medications. Besides this, they might have a high chance to remember the time to take their medication.
However, there is an inconsistent study done in India (44), Korea (45), and Northwest Ethiopia (29). The discrepancy might be due to India and Korea is a developed country in which all communities can easily access the media, health facility and reach the health facility on time. While the local discrepancy could be due to the study setting, more than three quarter (78.2%) of them were urban, whereas in the current study (67%) is urban.
BP control remains unsatisfactory in all countries of the world and several factors have been identified which hinder BP control. From them, poor MA plays a tremendous role (14). In this study, those who had controlled BP were four-time more adherent than those who had uncontrolled BP. This finding in line with the study done in Uzbekistan (33), Romania (19), Ghana and Nigeria (46), University of Gondar hospital (28) and Hawassa referral hospital (15).
The association could be explained that controlled BP might be contributing to better outcome of treatment, offer the patient good satisfaction and creates strong motivation of the patients towards the treatment. But, uncontrolled BP could make the patient hopeless and low satisfaction, and come up with stop their treatment.
There is a significant association between the number of antihypertensive drugs taken and the adherence status of patients. In this study, those who took less than or equal to two drugs per day were three times more adherent than those who took three and more. This finding agreed with the study done in Brazil (47), United Arab Emirates (37), Algeria (25), Debre tabor general hospital (12), and JUSH (30). The association might be due to the fact that when the number of drugs taken by patients decreases, their ability to remember and memorize the proper intake of the drugs (right drugs at right time) increased. Besides, fewer drugs have fewer side effects, which ultimately increase the adherence status of patients.
Co-morbidities can worsen the conditions of patient's diseases and the burden of cost that decrease anti-hypertensive MA. This study revealed that individuals with one or more comorbidities were less adherent to their medication than the counterpart. This finding is supported by the study done in Debra tabor general hospitals, Algeria, and Iran (12, 25, 48). The possible reason could be due to a complicated treatment regimen for both HTN and comorbidities could result to poly-pharmacy and create fear on patients about its side effect that hinder the adherence of prescribed medication. Additionally, when patients have another added health problem, their attention could be diverted towards the newly developed disease.
This study inconsistent with the study done in India (14) and Saudi Arabia (38). The variation might be due to better health facilities accessibility increases the chance of early diagnosis and management of comorbidities, the ability to perceive the seriousness of their health condition and want to prevent further complications. Besides, experiencing more severe symptoms of other conditions increase the patients’ adherence to their medication.
Poor adherence and poor HTN control still unresolved big challenges for health care providers, but having information about the HTN and its treatment is a significant independent determinant of good adherence (32). In this study those who had good knowledge about HTN and its treatments were five-time more adhere than the counterpart. This finding in line with the study done in Debra tabor general hospital, Poland, United Arab Emirates, Nigeria, Kenya, Uzbekistan and India (12, 22, 32–34, 49, 50). The association might be due to good knowledge about HTN and its treatment creates a clear understanding and avoids confusion about the disease condition and its treatment.
In this study, those who used insurance coverage were two times more adherent than those who paid cost per their follow-up. This finding similar to the study done in Algeria (25) and Northwest Ethiopia (29). The association might be explained that insurance users didn’t worry about the cost of drug due to the burden of cost pay was already covered. However the present study contrary to the study done in Korea (45) and United Arab Emirates (37). The discrepancy might be due to Korea and the United Arab Emirates is a country in which the community can afford the cost of drugs and the health care facility.
This study includes the most important variables which have an association with anti-hypertensive MA and incorporates more public hospitals found in North Showa Zone. The MMAS-8 was used with 83% reliability and generalizes all hypertensive patients who had follow-up at North Showa Zone public hospitals. However, it didn’t include the private hospitals and patients who didn’t visit the hospitals during the data collection. Besides, it didn’t determine the cause and effects, and might have a bias of self-response.