Hossain Ahmed, Ahsan Gias Uddin, Hossain Mohammad Zakir, Hossain Mohammad Anwar, Sutradhar Probal, Alam Sarowar-E, Sultana Zeeba Zahra, Hijazi Heba, Rahman Syed Azizur, Alameddine Mohamad
College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
Department of Public Health, North South University, Dhaka, 1229, Bangladesh.
BMC Public Health. 2025 Jan 21;25(1):250. doi: 10.1186/s12889-025-21409-z.
Adherence to antihypertensive medication is crucial to control blood pressure (BP) and hypertension management outcomes. In Bangladesh, as in many other countries, poor adherence to medication represents a challenge to effective hypertension management. This study aims to investigate the prevalence and relationship between medication adherence and BP management among hypertensive patients in Bangladesh.
The PREDIcT-HTN study in Northern Bangladesh aims to evaluate major adverse clinical events in treated hypertensive patients. The study involves 2643 hypertensive patients from a medical center, with data collected through baseline information and yearly follow-ups until 2025. The first follow-up visit was conducted between January and March 2021. Following the 2020 ISH-global hypertension guideline, patients were classified as having controlled BP, grade-I, or grade-II uncontrolled BP. Patients were divided into three groups (good, moderate, and poor) based on their 9-item Hill-Bone medication adherence scale. A multinomial regression analysis was conducted to identify the association between medication adherence and BP control after adjusting potential confounders.
Analysis of 2276 hypertensive patients (mean age 51.31 ± 11.58 years) revealed that 36.1% had grade-I and 24.2% had grade-II uncontrolled hypertension. Most patients (78%) displayed moderate adherence, and 15% showed poor medication adherence. Certain patient subgroups had higher rates of poor adherence: females (17.1%) compared to males (12.2%), rural residents (22.4%) compared to city-dwellers (12.2%), and newly diagnosed patients (17.2%) compared to those diagnosed 2-5 years earlier (12.6%). Multivariable analysis found a strong association between medication adherence and BP control. Compared to poor adherence, moderate adherence (relative risk ratio (RRR):0.50, 95%CI:0.36-0.68) and good adherence (RRR:0.56, 95%CI:0.35-0.91) were associated with better control. Increasing age, rural living, and uncontrolled hypertension were also linked. Comorbidities worsened BP control, and managing multiple medications contributed to poor adherence and grade-II hypertension in patients.
The high prevalence of uncontrolled hypertension in Bangladesh underscores the need for improved treatment strategies. Addressing medication adherence is essential for better BP control, with particular attention needed for women, rural residents, and newly diagnosed individuals. A comprehensive approach is warranted, including strategies to enhance adherence, early diagnosis, personalized treatment, and simplified medication regimens. These efforts align with the UN's 2030 SDGs, emphasizing targeted interventions for equitable healthcare access and outcomes.
坚持服用抗高血压药物对于控制血压和高血压管理结果至关重要。与许多其他国家一样，在孟加拉国，药物依从性差对有效的高血压管理构成挑战。本研究旨在调查孟加拉国高血压患者中药物依从性与血压管理之间的患病率及关系。
孟加拉国北部的PREDIcT-HTN研究旨在评估接受治疗的高血压患者的主要不良临床事件。该研究涉及来自一个医疗中心的2643名高血压患者，通过基线信息和年度随访收集数据，直至2025年。首次随访于2021年1月至3月进行。根据2020年ISH全球高血压指南，患者被分类为血压得到控制、I级或II级血压未得到控制。根据9项Hill-Bone药物依从性量表，患者被分为三组（良好、中等和差）。在调整潜在混杂因素后，进行多项回归分析以确定药物依从性与血压控制之间的关联。
对2276名高血压患者（平均年龄51.31±11.58岁）的分析显示，36.1%患有I级高血压，24.2%患有II级高血压。大多数患者（78%）表现为中等依从性，15%表现为药物依从性差。某些患者亚组的依从性差率较高：女性（17.1%）高于男性（12.2%），农村居民（22.4%）高于城市居民（12.2%），新诊断患者（17.2%）高于2-5年前诊断的患者（12.6%）。多变量分析发现药物依从性与血压控制之间存在密切关联。与依从性差相比，中等依从性（相对风险比（RRR）：0.
