Department of Pharmacy, Saint Antoine hospital, HUEP, AP-HP, Paris, France.
Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France.
PLoS One. 2019 Jul 10;14(7):e0219266. doi: 10.1371/journal.pone.0219266. eCollection 2019.
Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa.
We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries.
We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries.
There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95%CI [1.79-2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95%CI [1.35-2.56] and middle vs. high wealth: OR: 1.42, 95%CI [1.11-1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p<0.001) but not in middle-income countries (p = 0.17). In addition, 26.5% of the patients admitted having stopped their treatment due to financial reasons and this proportion was 4 fold higher in the lowest than highest wealth group (47.8% vs 11.4%) (p<0.001).
This study revealed the high frequency of poor adherence in African patients and the associated factors. These findings should be useful for tailoring future programs to tackle hypertension in low income countries that are better adapted to patients, with a potential associated enhancement of their effectiveness.
在过去的几十年中，高血压在撒哈拉以南非洲的流行率显著增加。药物依从性差已被确定为高血压控制失败的主要原因。非洲的数据非常有限。
我们评估了药物的依从性，并确定了与撒哈拉以南非洲 12 个国家高血压患者低依从性相关的社会经济学、临床和治疗因素。
我们在中低收入国家的城市诊所进行了横断面调查。医生收集了高血压患者的人口统计学、治疗和临床数据。通过患者填写的问卷评估依从性。使用具有国家随机效应的逻辑回归调查与低依从性相关的因素。
共有来自 12 个国家的 2198 人参加了这项研究。总体而言，分别有 678（30.8%）、738（33.6%）和 782（35.6%）名参与者对降压药物的依从性较低、中、高。多变量分析显示，使用传统医学（OR：2.28，95%CI [1.79-2.90]）和个体财富指数（低 vs. 高财富：OR：1.86，95%CI [1.35-2.56]和中 vs. 高财富：OR：1.42，95%CI [1.11-1.81]）与药物依从性差显著相关。在分层分析中，这种根据个体财富指数的药物依从性差异仅在低收入国家观察到（p<0.001），而在中等收入国家则观察不到（p = 0.17）。此外，26.5%的患者因经济原因停止治疗，在财富最低组中，这一比例比财富最高组高 4 倍（47.8% vs 11.4%）（p<0.001）。
这项研究揭示了非洲患者药物依从性差的高频率和相关因素。这些发现对于制定针对低收入国家高血压的未来计划可能有用，这些计划更好地适应患者，并且可能提高其有效性。
