Adeoye Abiodun Moshood, Adebiyi Akindele Olupelumi, Adebayo Oladimeji Muritala, Owolabi Mayowa Ojo
Department of Medicine, University of Ibadan, badan, Nigeria.
Department of Community Medicine, University of Ibadan, badan, Nigeria.
Niger Postgrad Med J. 2019 Jan-Mar;26(1):18-24. doi: 10.4103/npmj.npmj_147_18.
Uncontrolled hypertension is a major risk for major cardiovascular events. While medication adherence determines blood pressure (BP) control, studies on treatment adherence among apparently uncontrolled hypertensives are sorely lacking in sub-Saharan Africa. We report the pattern and correlate of medication adherence among the uncontrolled hypertensive population.
We investigated 148 age- and sex-matched hypertensive adults on anti-hypertensive medication for a minimum of 1 year. Apparent uncontrolled BP was defined as clinic BP ≥140/90 mmHg, whereas 24-h ambulatory BP monitoring was used to determine the true uncontrolled hypertension and other BP phenotypes. Using the 8-item Morisky medication adherence scale participants were classified into high, moderate and low adherence while Modified Morisky Scale was used to assess knowledge and motivation.
The mean age and BP were 61 ± 13.3 years and 158/91 mmHg, respectively. High adherence was found in 4.1% of the participants while 68.9% and 27% had moderate and low adherence, respectively. A third had true uncontrolled hypertension. A high proportion of the study participants also had a high motivation (68.9%) and knowledge (89.2%). Medication adherence was associated with motivation (P = 0.0001), knowledge (P = 0.002) and obesity (P = 0.036). Knowledge was an independent determinant of medication adherence with no significant effect on BP control.
High medication adherence was low and a third had true uncontrolled hypertension. Knowledge was an independent predictor of medication adherence with no significant effect on blood control. High medication adherence rather than moderate adherence, and knowledge are indeed needed for adequate BP control.
未控制的高血压是主要心血管事件的主要风险因素。虽然药物依从性决定血压控制情况，但撒哈拉以南非洲地区严重缺乏关于明显未控制高血压患者治疗依从性的研究。我们报告了未控制高血压人群的药物依从性模式及其相关因素。
我们调查了148名年龄和性别匹配的高血压成年患者，他们接受抗高血压药物治疗至少1年。明显未控制的血压定义为诊所血压≥140/90 mmHg，而采用24小时动态血压监测来确定真正未控制的高血压及其他血压表型。使用8项Morisky药物依从性量表将参与者分为高、中、低依从性，同时使用改良的Morisky量表评估知识和动机。
参与者的平均年龄和血压分别为61±13.3岁和158/91 mmHg。4.1%的参与者为高依从性，而68.9%和27%的参与者分别为中度和低依从性。三分之一的人患有真正未控制的高血压。很大一部分研究参与者也有较高的动机（68.9%）和知识水平（89.2%）。药物依从性与动机（P = 0.0001）、知识（P = 0.002）和肥胖（P = 0.036）相关。知识是药物依从性的独立决定因素，对血压控制无显著影响。
高药物依从性较低，三分之一的人患有真正未控制的高血压。知识是药物依从性的独立预测因素，对血压控制无显著影响。要实现充分的血压控制，确实需要高药物依从性而非中度依从性，以及知识。
