ABSTRACT
BACKGROUND: Cardiovascular diseases account
for about 17 million deaths per year globally.Hypertension is responsible for
at least 45% of deaths due to heart disease. The number of people with
uncontrolled hypertension is increasing because of population growth and
ageing. A very high prevalence rate of hypertension of 29.7% was reported in
Cameroon. Hypertension requires long term management and follow-up. Adherence
to therapy is a key component of a successful management. Few studies have been
done in Cameroon regarding antihypertensive treatment adherence. This study was
therefore designed to assess the adherence status and associated factors to
antihypertensive therapy in hypertensive patients followed-up at Yaounde
General Hospital.
METHODS: This was a cross-sectional analytic
study conducted at the external consultation service of the cardiology unit of
the Yaounde General Hospital. This study was carried out over a period of seven
months (November 2017 - May 2018). Patients admitted into this study were
selected consecutively and those that met our inclusion criteria were selected
prior to interviewing. Two sitting blood pressure measurements were taken on
both arms with a pretested electronic sphygmomanometer. We assessed the
adherence level of the study population by using the validated Morisky 8-item
medication adherence scale. Patients with a score of 8 on the scale were
termedhighly adherent, medium adherers were those with a score of 6 to <8,
and those classified as lowadherers were those with a score of <6. Bivariate
and multivariate analyses were carried out to assess associations of each
independent variable with the dependent variable. Odds ratio and 95% confidence
interval were used to identify the presence and strength of association.
Statistical significance was considered at P-value < 0.05.
RESULTS:Of the 181 patients screened, 175
were retained for the study. Sex ratio of participants was 1.2 with male
predominance of 54.90%. The mean age was 60 years. Most participants (88.60%)
lived in urban areas and 51.43% had a non-liberal profession, the majority
(66.30%) lived as couples and 40.00% had a higher level of education. Trip
duration to the hospital was less than one hour for84.60% of participants. The
high socioeconomic status (60%) was highly representedin this study and 10.9%
of participants had a health insurance.The High Normal blood pressure group was
most represented (24.60%) and 57.70% had acontrolled BP. The most frequently
encountered comorbidity was heart failure(24.57%). Only 18.29% of participants
had a handicap. Calcium channel blockers were the most encountered monotherapy
(31.90%). The mean treatmentcost was 14543FCFA and most participants were in
the 10000-20000FCFAmonthly drug cost range. Poor adherence was observed in
32.60% of study participants. After multivariate analysis with logistic
regression, 9 variables were significantlyassociated with poor adherence: first
cycle secondary education (p=0.0209; odds ratio=4.6623), living
singly(p=0.0003; odds ratio=4.6623), tripduration of one hour or more (p=0.008;
odds ratio=7.3925), middle socioeconomic status (p=0.006; odds ratio=2.6814),
uncontrolled blood pressure status(p<0.0001; odds ratio=5.5704),presence of
handicap (p=0.0117; odds ratio=4.1222), monotherapy (p=0.0295; odds
ratio=2.0721), presence of side effects (p<0.0001; odds ratio=11.5143), and
taking medication inthe evening (p=0.0399; odds ratio=2.5452).Of the 74
patients with uncontrolled BP, 86.49% had poor adherence. Only 54.30% of
participants were knowledgeable about hypertension.
CONCLUSION: 9 predictive factors of poor
adherence were identified: first cycle secondary education, living singly,
tripduration of one hour or more, middle socioeconomic status, uncontrolled BP
status,presence of handicap, monotherapy, presence of side effects, and taking
medications inthe evening. Addressing these factors could help health care
providers better foster drug adherence.
Keywords: Adherence, antihypertensive, Morisky,
Yaounde
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