INTRODUCTION:

Hypertension is a major health problem in developing and developed countries, and its increasing epidemic is a serious warning to take more attention to this silent disease^1.Hypertension is high blood pressure, a very common condition in older adults. Blood pressure is the physical force exerted by the blood as it pushes against the walls of the arteries. Normal blood pressure is below 120/80, blood pressure between 120/80 and 139/89 is pre-hypertension and blood pressure 140/90 or above is considered hypertension². An elevated blood pressure means that the heart must work harder to pump blood. High blood pressure can also damage the walls of the arteries. Over time, hypertension increases the risk of heart disease, kidney disease, and stroke^3.It is estimated that one in three adults in America are affected by hypertension.

Hypertension may not produce any symptoms, even if you have had it for years. That's why it is sometimes referred to as a "silent killer^.4.Globally, it is also one of the major causes of premature death, and 7.1 million of people die from hypertension related diseases annually and the problem is still growing ^5.Successful control of blood pressure is of paramount importance in the reduction of morbidity and mortality rates^6. and many studies have demonstrated the impact of antihypertensive agents on improving clinical outcomes^6–8.Although the control of blood pressure has improved considerably, poor adherence with medication treatment remains a major problem among hypertensive patients, and has been identified as one of the main causes of failure in achieving blood pressure control ⁹.

Uncontrolled hypertension is caused by non-adherence to the antihypertensive drugs, patients understanding their drug treatment help to improve their adherence,¹⁰thus will help prevent the complications of hypertension that are debilitating and if not prevented can increase the burden of a disease that is already on the increase ¹¹ .It is generally believed that, anti-hypertensive medications are effective in reducing high blood pressure and have been shown to significantly reduce the risk of cardiovascular illness¹². Adherence or orders and information compliance are influenced by patient's beliefs and their health conditions^13.Some studies have shown negative attitudes of hypertensive patients toward their disease. These perceptions may also be important in patient compliance and performance improvement ^14..

This study aims to assess the drug adherence profiles of patients prescribed antihypertensive agents, and to examine the factors associated with antihypertensive drug adherence among the patients. Self-reported survey as a tool to measure drug adherence was used in this study to supplement the findings of previous research reports. As this study evaluated additional factors including education level, and self-perceived health status which have not been explored among patients in previous studies^15–16, the findings of this study could provide more comprehensive information for physicians and health care policy makers with targets to improve medication adherence. This study was aimed to assess the adherence profiles and the factors associated with antihypertensive drug adherence among hypertensive patients.

METHODS AND MATERIALS:

STUDY DESIGN: A Cross Sectional Study

Study Site: ESI Hospital, Ayanavaram

Study Period:6 months

Study Population: 60 patients

Statistical Method: T-test to be done

Inclusion Criteria:

· Patients above 25 years of age

· Patients diagnosed with hypertension.

· Patients willing to participate in the study.

Exclusion Criteria:

· Patients having uncontrolled hypertension associated with diabetes

· Patients who are not willing to participate in this study.

Results:

The following results were obtained when the data were collected from the patient

Table: 1 Age Wise Distribution

Age in years	No. of patients (n=60)	Percentage of patients
25-35	04	6.6%
35-45	11	18.4%
45-55	18	30%
55-65	18	30%
65-75	9	15

Table 2: Gender Wise Distribution

Gender	No. of patients (n=130)	Percentage of patients
Male	30	50%
Female	30	50%

Out of selected 60 patients, 25 patients (50%) were male patients, and 60 patients (50%) were female patients, the study confirms that both the genders were equally affected with hypertension

Table 3: Social Habits Wise Distribution

Social Habits	No.of Patients (n=50)	Percentage of Patients (%)
Smoker	10	16.6%
Alcoholic	05	8.4%
Both	20	33.4%
None	2525	41.6%

Out of selected 60 patients, 22 patients (16.6%) are smoker, 5 patients (8.4%) are alcoholic and remaining 20 patients (33.4%) don’t have any social habits. In this study people who prone to smoking were affected.

Table 4: BMI Wise Distributions

BMI	Category	Percentage of patients
19-28	Normal	50%
29-38	Obese	50%

Out of selected 60 patients, 50% of patients are in 19-28 BMI index, and remaining 50% patients are in 29-38 BMI index respectively. In this study obese patients are more affected compare to normal.

Table 5: Duration Of Drugs Used

Duration Antihypertensive Drugs Used	No of patient (n-60)	Percentage (%)
5 years	20	33.4
5-10 years	22	36.6
10-15 years	18	30

Out of selected 60 patients ,20 patients are (33.4%) below 5years and 22 patients are (36.6%) 5-10 years are remaining 18 patients are (30%) 10-15 years. In this study patient mostly used antihypertensive drugs 5-10 years.

Table 6: Baseline Characters

Parameters	Total population	Women	Men
N	60	30	30
Age (years)	51.28±10.78	53.4±12.40	49.7±9.34
BMI (kg/m²)	26.75±4.41	27.72±3.70	26.06±4.79
Systolic BP (mm Hg)	128.2±14.39	128±16.21	128.3±13.1
Diastolic BP (mm Hg)	79.01±9.54	77.6±0.21	80.02±9.05

Our study results according to baseline characteristics of 30 men and 30 women shows the age mean ± standard deviation of male and female subjects was 53.4±12.40 years and 49.7±9.34 years respectively. Depending on the BMI female subjects are significantly affected when compared to male. Systolic and diastolic pressure for both female and male appears normal.

Table 7: Adherence Rate Before Counselling

Adherence

No of patients

(n-60)

(%)

Mean

+sd

P value

Good adherence

16.6%

3.55±2.17

<0.0001

Poor adherence

83.3%

6.2±1.61

Out of selected 60 patients 10 (16.6%) patients shows good drug adherence and 83.3% shows poor drug adherence before counselling.

Table 8: Adherence Rate After Counselling

Adherence

No of patients

(n-60)

(%)

Mean

+sd

P value

Good adherence

75%

6.35+1.36

<0.0001

Poor adherence

25%

4.26+1.36

Out of selected 60 patients 45 (75%) patients shows good drug adherence and 15 (25%) patients shows poor drug adherence after counselling.

Table 9: Before and After Counselling

Parameters	Before counseling	After counseling
Good adherence	3.55±2.17	6.35±1.35
Poor adhernce	6.2±1.61	4.26±1.36
P-value	<0.0001	<0.0001^*
*indicating that the value is extremely significant

It can be seen that there is an extremely significant (P<0.0001) values were obtained when compared between before counselling and after counselling phases. Patient’s drug adherence improved extremely significant after counselling.

DISCUSSION:

A study conducted by Ramli et al with medication adherence Scale (modified of HILL-BONE CHBPTS and Morisky medication adherence scale) documented higher proportion of non-adherence. They also addressed non-adherence issues of forgetting, missing and running out of hypertension medications.

This article focuses on the issue of medication adherence in Indian hypertensive patients in tertiary care hospital Chennai, using a specific hypertension medication adherence scale (HILL-BONE CHBPTS) and highlights the need to improve medication adherence in order to achieve optimal controlled blood pressure to prevent further hypertension related complications.

The purpose of this study was to study the adherence profiles of patients prescribed antihypertensive agents and the factors associated with drug adherence using a self-administered questionnaire.

The rate of adherence may differ by many factors, including types of population, study design, method of measurement, to quote a few. It has been reported that cultural factors might influence antihypertensive adherence which could explain different levels of adherence among different populations¹⁷. These include cultural health perception of hypertension, health perceptions of Western medications, self-care behavior and social support ^18..

Several studies have also evaluated the factors associated with antihypertensive drug adherence. This result supports the hypothesis of drug adherence play a role in hypertension ^19–21

Age, gender, the number of antihypertensive agents, and socioeconomic status were found to be associated with drug adherence. One of the studies conducted in a Chinese population²²has found that that many of the factors associated with antihypertensive drug adherence among Chinese patients were similar to those identified by studies conducted in Western populations. Among Chinese patients, there were previous studies which utilized Medication Possession Ratio (MPR) as a measure of adherence from retrospective dataset analysis,^22–25. These reports were different from this study which prospectively evaluated medication adherence using a self-reported instrument. We are of the view that both types of studies could be interpreted in different perspectives to inform the current situation of medication non adherence in Chinese patients.

In our study drug adherence is extremely significant after counseling compare to other studies.

Age, gender, duration of antihypertensive drugs wer found to be associated with drug adherence compare to other studies ^22..

Out of selected 60 patients, 4 patients (6.6%) were in group of 25-35 years, 11 patients (18.4%) were in group of 35-45 years,1 8 patients (30%) were in group of 45-55 years, 18patients (30%) were in group of 55-65 years, 9 patients (15%) were in group of 65-75 years. So in this study, it indicates that more number of people in the age group of 45-65 years is affected with hypertension. Out of selected 60 patients, 25 patients (50%) were male patients, and 60 patients (50%) were female patients, the study confirms that both the genders were equally affected with hypertension.

Out of selected 60 patients, 50% of patients are in 19-28 BMI index, and remaining 50% patients are in 29-38 BMI index respectively. In this study obese patients are more affected compare to normal.

The result indicates that there is good drug adherence after counselling.

CONCULSION:

In this study 60 hypertension patients were included. The aim of the study is to improve the health related adherence medication among hypertension patients. The study concludes that incidence rate of male patient is affected more similar female patient in the age group 45-65years is affected with hypertension compared to other age group.

From our study using MMAS-8 form to assess the hypertension patients’ general, physical, mental, social, pain and limitations, we conclude that patients with hypertension have relatively poor adherence of life pertaining to physical health components but less impact was seen on the patients mental health. The adherence medication is negatively affected by increasing level of pain, age, gender and social habits. Thus the present study suggests that the perception and the physical and mental health component score is improved in hypertension patients after counselling.

A clinical pharmacist can play a major role in improving the patient’s knowledge and adherence by patient education and developing maintenance of diet of patient enjoyment in day to day life activities and reduce the majority of morbidity rates by continuing education programs

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Received on 15.05.2017 Modified on 08.06.2017

Research J. Pharm. and Tech 2017; 10(11): 3779-3782.

DOI: 10.5958/0974-360X.2017.00685.0