Adherence to antihypertensive medication in Russia: a scoping review of studies on levels, determinants and intervention strategies published between 2000 and 2017

Abstract

Background Arterial hypertension (HT) is common in the Russian adult population, with half of affected individuals inadequately controlled. Low adherence to medication seems likely to be a factor. We report a scoping review of studies on adherence to antihypertensive therapy (AHT) in Russia to determine the extent of research undertaken, the frequency of adherence among adults diagnosed with HT, methodologies used in the studies, and their ability to describe determinants of adherence. Methods A scoping review of published studies that have assessed adherence to AHT in Russian HT patients searched the main Russian and international electronic databases eLIBRARY.ru, Russian Medicine, Embase, MEDLINE for full-text reports published in the Russian language between 2000 and 2017. The last search was on November 28, 2017. Among 520 reports identified, 31 were included in the review. Results Eighteen studies assessed adherence using the 4-item Morisky Medication Adherence Scale (MMAS-4); others used bespoke questionnaires or pill counts. 25 studies assessed levels of adherence, 11 examined its determinants, and 18 examined intervention strategies. The proportion of “adherent” patients varied from 11 to 44% using the MMAS-4, from 23 to 74% when using bespoke questionnaires, and from 5 to 43% when using pill counts. Adherence was associated with sociodemographic factors, access to free drugs provided through the Medicine Assistance Scheme (MAS), use of home blood pressure (BP) monitoring, anxiety, and comorbidity. There was no evidence that adherence was associated with income or physical activity. Evidence of an association between MAS, grade of HT, or experience of hypertensive crisis was inconclusive. Various methods to improve adherence were studied including patient education (improved from 1.8 to 3.9 points, p = 0.0002 or 2.80 to 3.79 points, p < 0.0001 measured by the MMAS-4), telephone reminders (p < 0.0001), training in home BP monitoring (p < 0.05), and use of fixed-dose combinations (p < 0.05). Conclusions The main determinants of adherence to AHT are sociodemographic characteristics, the severity of HT, and presence of comorbidity. Patient education and use of fixed-dose combinations of drugs were identified as most important for improving adherence. Most studies assessing adherence use self-reported methods so there is a need for greater use of objective methods. Trial registration This scoping review has not been registered.

Psycho-behavioural factors associated with medication adherence among male out-patients with hypertension in a Ghanaian hospital

“…Socio-demographic factors have been reported to contribute to the medication adherence behaviour of patients with hypertension in general and among hypertensive men in particular [13,14,39,40]. Contrary to other studies where increasing age was associated with improved medication adherence, this study showed that the odds of patients adhering to medication significantly decreased by 3% with every year advancement in age.…”

Uncontrolled and apparent treatment resistant hypertension: a cross-sectional study of Russian and Norwegian 40–69 year olds

“…could compound the effectiveness of hypertension control for individuals. A recent review of Russian hypertension research found evidence that lower education and single status were associated with lower adherence but differences were not significant in this study [19], perhaps because of insufficient power to detect such a difference. The prevalence of aTRH was 9.8% in KYH and 5.7% in Tromsø 7.…”

“…Poor adherence to antihypertensive therapies may also play a role in the levels of uncontrolled hypertension observed in both studies. Many of the factors found to be associated with uncontrolled hypertension overlap with known factors for poor drug adherence [19,22] and health check non-attendance [23], i.e. male gender, no primary care visit in the past year, problem drinking, and absence of CVD history.…”

“…Greater use of multi-drug combinations could potentially reduce prescription errors and improve adherence by reducing the "pill burden" for patients [26], but typically reduces treatment options in terms of dose, formulation, and more individualised prescribing. A recent review of Russian antihypertensive adherence studies however concluded that patient education, telephone reminders, home blood pressure monitoring, and fixed drug combinations were the most important factors for improving adherence [19].…”

“…Statistical analyses were carried out using Stata 15 [18]. CVD history was included in the adjusted analyses together with gender and age due to the well-known differences in CVD burden between the two countries and the higher propensity for being and staying on antihypertensives for this group [19]. Potential interactions between age group, gender, age group, and CVD history for the two outcomes were tested with likelihood ratio tests in a restricted versus unrestricted model scenario.…”