Patient-related barriers to hypertension control in a Nigerian population

Abstract

BackgroundHypertension control is a challenge globally. Barriers to optimal control exist at the patient, physician, and health system levels. Patient-related barriers in our environment are not clear. The aim of this study was to identify patient-related barriers to control of hypertension among adults with hypertension in a semiurban community in South-East Nigeria.MethodsThis was a cross-sectional descriptive study of patients with a diagnosis of hypertension and on antihypertensive medication.ResultsA total of 252 participants were included in the survey, and comprised 143 males (56.7%) and 109 females (43.3%). The mean age of the participants was 56.6±12.7 years, with a diagnosis of hypertension for a mean duration of 6.1±3.3 years. Among these patients, 32.9% had controlled blood pressure, while 39.3% and 27.8%, respectively, had stage 1 and stage 2 hypertension according to the Seventh Report of the Joint National Committee on Prevention, Detection and Evaluation of High Blood Pressure. Only 23.4% knew the consequences of poor blood pressure control and 64% were expecting a cure from treatment even when the cause of hypertension was not known. Furthermore, 68.7% showed low adherence to medication, the reported reasons for which included forgetfulness (61.2%), financial constraints (56.6%), high pill burden (22.5%), side effects of medication (17.3%), and low measured blood pressure (12.1%). Finally, knowledge and practice of the lifestyle modifications necessary for blood pressure control was inadequate among the participants.ConclusionPoor knowledge regarding hypertension, unrealistic expectations of treatment, poor adherence with medication, unawareness of lifestyle modification, and failure to apply these were identified as patient-related barriers to blood pressure control in this study.

Non-Adherence to Antihypertensive Drugs: A Systematic Review and Meta-Analysis

“…Finally, 28 articles were included in the systematic review and 25 of these were included in the meta-analysis. [9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][27][28][29][30][31][33][34][35][36] …”

“…Nine of the studies were conducted in the United States, [11,12,15,26,29,30,32,33,35] and 2 each in China, [11,17] Nigeria, [16,22] Hong Kong, [21,25] and Iran. [10,18] Countries such as Uganda, Lebanon, Kenya, Republic of Korea, Peru, Ethiopia, Ghana, Malaysia, Palestine, Brazil, and Italy were represented with a single study.…”

“…[9,13,19,20,23,24,27,28,31,34,36] These studies were conducted on hypertensive patients to assess medication adherence using MMAS-8 between January 2009 and March 2016. Twenty-four studies were cross-sectional [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and others were cohort, [35] observational, [36] and interventional studies. [32] Only 1 randomized controlled trial (RCT) was found.…”

“…[29] The sample size of studies ranged from 25 [32] to 2445 [21] subjects. Eleven studies assessed adherence through face-to-face interviews, [10,14,18,20,[22][23][24]26,[29][30][31] while 8 studies used selfadministered questionnaires, [13,17,21,25,[32][33][34]36] and only 1 study was administered through a telephone interview. [35] However, 8 studies did not specify the type of MMAS-8 questionnaire administered.…”

“…[35] However, 8 studies did not specify the type of MMAS-8 questionnaire administered. [9,11,12,15,16,19,27,28] Except 1 study, [22] all the included studies met the quality criteria and showed high quality (>75%). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][29][30][31][32][33][34][35][36] …”