Non-adherence to anti-hypertensive medications in a low-resource country Nepal: a systematic review and meta-analysis

Abstract

Background: Nepal is a low resource country with cardiovascular diseases being the number one cause of mortality. Despite hypertension being the single most important risk factor for cardiovascular diseases, non-adherence to anti-hypertensive medications has not been assessed systematically. So, this systematic review and meta-analysis aims to analyze the prevalence of non-adherence to anti-hypertensive medications in Nepal. Methodology: This systematic review and meta-analysis was piloted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic databases of Embase, PubMed, Scopus, Web of Science, Cochrane Library, Cinhal Plus, and Google Scholar were searched from inception till 1 February 2023. The random-effects model with 95% confidence interval (CI) was used to calculate the non-adherence rate. Results: Altogether, 14 studies with a total of 3276 hypertensive patients were included in the meta-analysis. The pooled prevalence of non-adherence to anti-hypertensive medications was 49% (95% CI: 0.37–0.62, I 2=98.41%, P<0.001). The non-adherence rate using Morisky Medication Adherence Scale (MMAS) was 55% (95% CI: 0.34–0.76, I 2=99.14%, P<0.001), and using Hill–Bone Compliance Scale, the non-adherence rate was 45% (95% CI: 0.37–0.54, I 2=84.36%, P<0.001). In subgroup analysis, the non-adherence was higher in rural areas 56% (95% CI: 0.51–0.61, I 2=0.0%, P=0.46) compared to urban areas 42% (95% CI: 0.31–0.54, I 2=96.90%, P<0.001). The trend of non-adherence was increasing after 2020. Additionally, forgetfulness, carelessness, cost of medications, number of comorbidities, and using an alternate form of medication were common factors associated with non-adherence. Conclusions: This meta-analysis showed that half of the hypertensive population of Nepal are non-adherent to their anti-hypertensive medications, thereby posing a significant long-term cardiovascular consequence among Nepali population.

Adherence to antihypertensive medication and its associated factors among patients with hypertension attending a tertiary hospital in Kathmandu, Nepal

“…The study done in the community setting of Nepal reported that 37.5% [ 12 ] of hypertensive patients had a high level of adherence whereas in a hospital setting, only 23.9% [ 13 ] of hypertensive patients had a high level of adherence. The recent meta-analysis of Nepal reported that half of the hypertensive population of Nepal is non-adherent to their anti-hypertensive medications, posing a higher risk of cardiovascular events [ 14 ].…”

“…Therefore, it is crucial to identify the factors associated with adherence to antihypertensive medication to improve the control of blood pressure among patients with hypertension in Nepal [ 14 ]. Several studies have reported the presence of co-morbidity, alcohol consumption, self-purchasing of medications [ 7 , 14 ], forgetfulness [ 13 , 14 ], unavailability of hypertensive medicines at the nearest health facilities [ 15 ], large number of medications prescribed, irregular follow-up [ 16 , 17 ], etc., were all linked to non-adherence to antihypertensive medication and all identified factors were modifiable.…”

“…Therefore, it is crucial to identify the factors associated with adherence to antihypertensive medication to improve the control of blood pressure among patients with hypertension in Nepal [ 14 ]. Several studies have reported the presence of co-morbidity, alcohol consumption, self-purchasing of medications [ 7 , 14 ], forgetfulness [ 13 , 14 ], unavailability of hypertensive medicines at the nearest health facilities [ 15 ], large number of medications prescribed, irregular follow-up [ 16 , 17 ], etc., were all linked to non-adherence to antihypertensive medication and all identified factors were modifiable. Although several studies have shown the prevalence of hypertension, level of medication adherence and factors associated with adherence to antihypertensive medications in some parts of Nepal [ 13 , 15 – 17 ], there is limited evidence on medication adherence at the tertiary level hospital in Nepal.…”