Öz
Background: Hypertension has been found to be one of the preventable risk factors for renal, cardiac and blood vessel diseases and hence there is a need to achieve control. Despite new guidelines and development of new drugs in treatment of hypertension, a significant number of patients remained uncontrolled. Adherence has been found to affect blood pressure control according to literature. Demographic characteristics, severity of disease, number of drugs and doses prescribed and side effects of some drugs have been found to affect adherence. Achieving good control of hypertension will reduce rate of emergency admissions, health care expenses, strain in family income, days off work, depression and invariably improve quality of life in patients with hypertension.
Aims: To evaluate the predictors of adherence to treatment of hypertension among patients attending Medical Outpatients clinic at a secondary health care facility in southwest Nigeria.
Methods: The study was a cross sectional study of 386 randomly selected adults with uncontrolled hypertension aged between 18years and 70years on treatment and follow up conducted at the Medical Outpatient clinic of the State Hospital Oyo. Chi-square test was used for bivariate analyses to test the significance of the association between categorical variables and adherence to medications. Logistic regression analysis was performed for the various factors to show the predictors of adherence to treatment of hypertension. Data was analyzed using Statistical Package for Social Sciences (SPSS) soft-ware version 15 and a p-value of < 0.05 was considered to indicate statistical significance.
Results: Hypertensive patients with monthly income of > N13, 600 were about three times more likely to have good treatment adherence compared to those who were earning < N13,600 monthly. ( OR= 2.815 ; 95% CI= 1.103 – 7.186 ). Also, hypertensive patients on single medication were about six times more likely to have good adherence to medications compared to those on three drugs( OR= 6.184; 95%CI=1.141 - 33.533 ).
Conclusion: The predictors of good adherence to anti-hypertensive therapy included monthly income and the number of drugs used by the patients. The prescriptions of efficacious, cost-effective medications, single dose daily therapy with minimal side effects will improve patient adherence to therapy.
Keywords: Hypertensive, adults, treatment, adherence
Résumé
Contexte : L’hypertension s’est avérée l’un des facteurs de risque évitables des maladies rénales, cardiaques et des vaisseaux sanguins ; il est ainsi nécessaire de parvenir à un contrôle. Malgré les nouvelles directives et le développement de nouveaux médicaments pour le traitement de l’hypertension, un nombre important de patients sont restés non contrôlés. L’adhérence affecte la régulation de la pression artérielle selon la littérature. Les caractéristiques démographiques, la gravité de la maladie, le nombre de médicaments et les doses prescrites, ainsi que les effets indésirables de certains médicaments ont des effets sur l’adhérence. Un bon contrôle de l’hypertension réduira le taux d’admission d’urgence, les dépenses de santé, la pression sur le revenu familial, les journées de congé, la dépression et améliorera invariablement la qualité de vie des patients hypertendus.
Objectifs: Pour évaluer les facteurs prédictifs de l’adhérence au traitement de l’hypertension chez les patients fréquentant une clinique de consultations externes dans un établissement de soins de santé secondaire situé dans le sud-ouest du Nigéria.
Méthodes : L’étude était une étude transversale portant sur 386 adultes sélectionnés aléatoirement, atteints d’hypertension non contrôlée et âgés de 18 à 70 ans, traités et suivis à la clinique de consultations externes de l’hôpital public de l’État à Oyo. Le test du chi carré a été utilisé pour les analyses bivariées afin de tester la signification de l’association entre es variables catégorielles et l’adhérence aux médications. Une analyse de régression logistique a été réalisée pour les différents facteurs afin de montrer les facteurs prédictifs de l’adhérence au traitement de l’hypertension. Les données ont été analysées à l’aide de la version 15 du logiciel SPSS (Statistical Package for Social Sciences) et une valeur-p < 0,05 a été considérée comme indiquant une signification statistique.
Résultats : Les patients hypertendus avec un revenu mensuel > N13.600 étaient environ trois fois plus susceptibles d’avoir une bonne adhérence au traitement par rapport à ceux gagnant moins de ¦ N13.600 par mois. (OR = 2,815; IC à 95% = 1,103 à 7,186). En outre, les patients hypertendus qui prenaient un seul médicament avaient environ six fois plus d’adhérence au traitement que ceux qui prenaient trois médicaments (OR = 6,184; IC à 95% = 1,141 - 33,533).
Conclusion : Les prédicteurs de la bonne adhérence au traitement antihypertenseur comprenaient le revenu mensuel et le nombre de médicaments utilisés par les patients. Les prescriptions de médicaments efficaces et rentables, une thérapie quotidienne à dose unique avec des effets secondaires minimes amélioreront l’observance du traitement par le patient.
Mots - clés : Hypertension, adultes, traitement, adherence
Correspondence: Dr. I.A. Azeez, State Hospital, Oyo, Nigeria. E-mail: kunleayilola14@gmail.com
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