Abstract

Adherence to antihypertensive medication is critical for effective management of hypertension and the prevention of related complications. This study assesses the factors associated with non-adherence to antihypertensive medication among patients at Buea Regional Hospital in Cameroon, aiming to identify key determinants that influence medication adherence.

A cross-sectional study was conducted with 300 hypertensive patients receiving care at Buea Regional Hospital. Data were collected through structured questionnaires, which evaluated patients’ medication adherence, demographic characteristics, healthcare access, and potential barriers to adherence. Medication adherence was measured using the Morisky Medication Adherence Scale (MMAS-8) and cross-referenced with patients’ medical records to confirm adherence levels.

The study revealed that 40% of the participants exhibited low adherence to their antihypertensive medication regimen. Factors significantly associated with non-adherence included financial constraints (45% of non-adherent patients), lack of understanding of medication importance (30%), and side effects experienced (25%). Additionally, 20% of patients reported difficulties with accessing healthcare facilities and obtaining medications due to logistical issues.

Demographic factors such as age, education level, and socioeconomic status also influenced adherence. Younger patients and those with lower levels of education were more likely to exhibit non-adherence. Patients from lower socioeconomic backgrounds faced greater challenges in affording medications and consistently accessing healthcare services.

Healthcare provider factors were also significant. Patients who received insufficient counseling and education about their medication regimen were more likely to be non-adherent. The study found that patients who reported receiving clear instructions and support from healthcare providers had higher adherence rates.

Barriers to adherence identified in the study included complexity of medication regimens, perceived ineffectiveness of medication, and forgetfulness. Financial difficulties and logistical issues further compounded these barriers, leading to inconsistent medication use.

In conclusion, non-adherence to antihypertensive medication among patients at Buea Regional Hospital is influenced by a combination of financial, educational, and healthcare-related factors. Addressing these factors through improved patient education, better access to medications, and more comprehensive support from healthcare providers is essential for enhancing adherence rates and improving hypertension management outcomes. Targeted interventions that consider these barriers can help achieve better control of blood pressure and reduce the risk of hypertension-related complications.

Keywords

Hypertension, medication adherence, Buea Regional Hospital, antihypertensive medications, financial constraints, patient education, healthcare access, adherence barriers.

CHAPTER ONE INTRODUCTION

Hypertensive medication non-adherence continues to become the common cause of hypertensive complications like heart attacks, heart failure, stroke and other complications (WHO, 2013). One way of managing hypertension (HPT) to an optimal blood pressure control level is by use of antihypertensive medication. The success of antihypertensive drugs is well recognized and has been measured in terms of reduction of overall relative risk of cardiovascular disease and other hypertensive complications like stroke and as well as lower healthcare costs (Dragomir et al., 2010). Hypertension condition has remained to be known as the main common reason of cardiovascular- related morbidity and deaths globally (Crim et al., 2012). The definite prevalence of non-adherence to hypertensive medication is unknown. The available data propose that poor adherence could be more common than complete adherence to antihypertensive medication (Hendriks et al., 2012, Mazzaglia et al., 2013)

Poor hypertension control results mostly due to non-adherence to medications. Approximately 45-81 percent of patients worldwide with HPT have poor blood pressure control (Persell, 2011). Despite the widespread availability of antihypertensive medications, national hypertensive guidelines for detecting and treatment, and regular interactions with the system in health, a significant number of detected hypertensive adult’s remain with poor controlled blood pressure (Panjabi et al., 2013). This may be due to non-adherence to medication, diet and lifestyle causes, interfering medications, or underlying diseases.

Compliance to hypertension drugs is a key factor to avoiding poor controlled hypertension and the possibilities of developing complications linked to hypertension for example renal failure, heart attacks, strokes and eye complications which are dangerous and can lead to sudden death (Desimioni et al., 2013, Brinker et al., 2014). Additionally, patients with unrecognized non-adherence most often go through numerous further investigative tests which are invasive and more costly some times, and in expert centers to detect reasons of their poor response to antihypertensive treatment. Additionally, patients who do not adhere to antihypertensive therapy fail to achieve the confirmed benefits of BP lowering therapy and continue to be at high risk of cardiovascular complications (Perreault et al., 2012, Corrao et al., 2011).

Antihypertensive medication non-adherence is a possible causative factor to the event of hypertensive complications. A number of analyses have revealed that in developed countries, not adhering to long term therapeutics including HPT therapy in the population, has high prevalence (Arshia et al., 2010). Mathenge et al., (2010) revealed that only 29% of patients under treatment had their BP contained in the recommended levels of < 140/90 mmHg. Non-adherence to hypertensive medication in many hospitals is characterized by failure to refill the regimen, failing to honor appointments, patients stopping medication when they felt better or due to the side effects. Several approaches have been tried to explore the drugs taking behavior and the traditional methods like clinical reports, pill counts, and patients reported measures and prescription refills were examined. Studies identified income, age, gender and education as demographic factors leading to hypertensive medication non adherence (Bruce et al., 2015). Such demographic investigation are essential, but they have a tendency to limit comprehension of the multifaceted set of influences that in collaboration or on their own effect non-compliance in regards to termination of taking medication or omitting dosages (McMullen et al., 2015).

Non adherence outcome places the burden to economy which affects the decision on how to make use of the scarce health resources, can lead to absenteeism or low work productivity or even can lead to premature deaths. Non-adherence outcome on health by not complying to treatment properly can result to drug resistance, progression of disease, treatment failure, tolerance to drugs and drug related morbidity (Psaty et al., 1990).

This study was thus expected to identify some of these factors influencing non- adherence to antihypertensive medication at local level due to some differences in cultural background or effects of the health system and thus would enable the clinicians to concentrate more on those subgroups at higher risk of low adherence. Interventions will be tailored towards those found to be at risk of poor adherence and will impact positively in improving adherence levels to hypertension treatment. Reports from Buea regional hospital records showed that hypertension was amongst the top leading causes of both outpatient and in-patient morbidities and mortalities. In 2016, 560 hypertensive patients attended Buea regional hospital with hypertension, 140 with hypertensive complications out of which 16 died due to hypertension complications

1.1  Statement of the Problem

The medical treatment non-adherence remains a great challenge to social scientist and medical professions. It has been recognized that antihypertensive medication non- adherence is the most significant cause of poor controlled blood pressure (BP). Despite the more knowledge and various advances through compliance/adherence research, non- adherence rate have continued unchanged in the last decade. Consequently, most patients with hypertension do not achieve optimal control of blood pressure and fails to reap total benefit of medical treatment. This result to poor outcomes in health, burden in health care cost and lower quality of life. Associated factors of non-adherence are

complex, are both internal and external to the patient but most significantly, and are difficult to extrapolate. This can partly be because the determinants of non-adherence to hypertensive, may have a locality effect due to many factors such culture and health system in a given locality. Therefore, there was need to study the factors associated with non-adherence at a local scale.

1.3.  Objectives of the Study

This research was guided by both broad and specific objectives.

1.3.1 main Objective

To evaluate factors associated to non-adherence to antihypertensive medication among patients followed up Buea regional hospital

1.3.2  Specific Objectives

1. To establish patient related factors associated with non-adherence to antihypertensive medication among patients followed at Buea regional hospital.
2. To establish health system related factors associated with non-adherence to hypertension medication among patients followed at Buea regional hospital.

1.4  Specific Hypotheses

H01: There is no statistically significant association between patient related factors and non-adherence to anti-hypertensive medication among patients followed at Buea regional hospital.

H02: There is no statistically significant association between health systems related factors and non-adherence to antihypertensive medication among patients followed at Buea regional hospital.