Prevalence of non-adherence to antihypertensive medication in Asia: a systematic review and meta-analysis

Abstract

Background: Hypertension and its associated complications are one of the leading causes of morbidity and mortality in Asia. Racial disparities in terms of treatment outcomes among hypertension patients have been reported in literature with Asian patients resulting in poorer treatment outcomes. Non-adherence to antihypertensive therapy is frequently associated with poor treatment outcomes. Aim of the Review:The aim of this review was to estimate the prevalence of non-adherence to antihypertensive medications among patients with hypertension residing in Asia.Method: PubMed, Google Scholar, MEDLINE, Embase, Scopus, CINHAL and Cochrane library were searched for studies published between 2000 and 2019 involving hypertensive patients. Studies investigating the prevalence of medication non-adherence in Asian countries, rated either good or fair on National Institute of Health quality assessment tool and published in English language were included in our review. Data were extracted by one author and checked by another using a structured and pilot-tested data extraction sheet. A random-effects meta-analysis was performed using STATA version 14.3®. Results:Sixty-Seven studies from 22 Asian countries including 2,532,582 hypertensive patients were included. Mean (±SD) age of participants was 58(±6) years. Overall, the estimated prevalence of non-adherence to antihypertensive medication in Asia was 48% (95% CI: 41-54, P=0.001). The rate of non-adherence was higher among females 49% (95% CI: 41-56, P=0.001) compared to males 47% (95% CI: 40-53, P=0.001). As per the region, the highest prevalence of non-adherence was found in South Asia 48% (95% 44-51, P=0.877) followed by East Asia 45% (31-59, P=0.001) and the Middle East 41 (95% 30-52, P=0.001). Similarly, higher rate of nonadherence was observed in low and lower middle-income countries i.e. 50% (95% CI: 47-54, P=0.220) as compare to upper-middle and high-income countries i.e. 37% (95% CI: 25-49, P=0.001) and 44% (29-59, P=0.001) respectively. Conclusion:The prevalence of non-adherence to antihypertensive medication is high in Asia. This may partly explain poor treatment outcomes and incidence of higher mortality rate in Asia frequently reported in the literature. There is a need to implement appropriate policies and clinical practices to improve medication adherence.

Effectiveness and Acceptability of a Mobile Phone Text Messaging Intervention to Improve Blood Pressure Control (TEXT4BP) among Patients with Hypertension in Nepal: A Feasibility Randomised Controlled Trial

“…Our theory-informed intervention resulted in better patient engagement and motivation for behaviour change leading to effectiveness of the intervention in our study. Medication non-adherence is one of the major predictors of uncontrolled BP among patients with hypertension [47]. Text messages act as reminders to reinforce daily taking of medication [17] and address the issue of forgetfulness, which is identified as one of the barriers for medication adherence [48].…”

Medication Adherence and Treatment-Resistant Hypertension in Newly Treated Hypertensive Patients in the United Arab Emirates

“…To the best of our knowledge, this study is the first to determine that among newly treated hypertensive patients, one out of two patients would be nonadherent to antihypertensive medications, and one out of five taking three or more medications may have TRH. Studies have reported that adherence to pharmacotherapy for hypertension after treatment initiation is typically at <50% [ 2 , 8 , 10 , 22 , 27 ]. A recent meta-analysis reported that the overall nonadherence to antihypertensive medications in the Asian population was 48% (95% CI: 41–54%) and 41% for the Middle Eastern population (95% CI: 30–52) [ 27 ].…”

“…Studies have reported that adherence to pharmacotherapy for hypertension after treatment initiation is typically at <50% [ 2 , 8 , 10 , 22 , 27 ]. A recent meta-analysis reported that the overall nonadherence to antihypertensive medications in the Asian population was 48% (95% CI: 41–54%) and 41% for the Middle Eastern population (95% CI: 30–52) [ 27 ]. The rate of TRH in our study was much higher than a study conducted in Israel that reported a lower prevalence of TRH (2.2%) among patients with uncontrolled hypertension [ 28 ].…”

“…Current estimates on the prevalence of adherence to antihypertensive medication in the Middle East are based on cross-sectional studies and used self-reported questionnaires [ 27 ]. The reported proportion of medication adherence to antihypertensive therapy in this study (42%) is in concordance with adherence rates reported in Arabian Gulf countries, including Saudi Arabia (40%) [ 29 ], Oman (49%) [ 30 ], and two studies in the UAE (52% and 54%) [ 31 , 32 ].…”

The Potential to Reduce Patient Co-Payment and the Public Payer Spending in Poland through an Optimised Implementation of the Generic Substitution: The Win-Win Scenario Suggested by the Real-World Big Data Analysis

“…New studies prove that non-adherence is still equally prevalent. For example, a recent meta-analysis found the prevalence of non-adherence to antihypertensive medications in Asia to be 48% [ 2 ]…”