Medication Adherence in Patients With Uncontrolled Hypertension and Hypertensive Crisis Presenting to an Hospital Setting in Karachi, Pakistan

Abstract

Objective: Hypertension is an established risk factor for cardiovascular disease. Non-adherence to antihypertensive medications contributes to poorly controlled hypertension while also increasing the risk of hypertensive crisis. The aim of our study was thus to estimate the frequency of adherence to antihypertensive medications and also see if an association exists between adherence and the development of hypertensive crisis. Design and method: This cross-sectional study was undertaken on patients admitted to Aga Khan University Hospital between July 2020 and March 2022. All patients with uncontrolled hypertension with systolic blood pressure (BP) > 140 and diastolic BP > 90 were included. Hypertensive crisis was defined as a systolic BP over 180mm Hg or diastolic BP over 120mm Hg, with or without end organ damage. Adherence to medications was assessed using the 4 item Morisky Green Levine scale. A cumulative score of more than and equal to 3 signified adherence while a score of 0, 1 or 2 was classified as non-adherence. Results: We found that 64% of the cohort were adherent to their medications while 93(36%) were non-adherent. Depression was seen in 133(51.2%) while 147(56.5%) had anxiety. Similar rates were seen amongst males (49.1%) and females (50.9%) when stratified by adherence. The highest level of adherence was seen in the 61-75 years age group (34.9%). We also found statistically significant association of adherence to antihypertensive medications with anxiety (p value = 0.048). Moreover, in the hypertensive crisis group, 40.7% of the patients were adherent to their antihypertensive medications while 54.8% were found to be non-adherent, with p value reaching statistical significance (p = 0.028). Conclusions: We found a higher rate of adherence (64%) in this inpatient hypertensive population as compared to previous studies in our population. We also found that non adherence is a risk factor for the development of hypertensive crisis. Therefore, at clinic visits, physicians should assess their patient's adherence to antihypertensive medications to prevent the development of a hypertensive crisis, which is a potentially life threatening complication of uncontrolled hypertension.