Factors associated with adherence to antihypertensive treatment in Kiambu district hospital

Abstract

Introduction: Hypertension is a chronic medical condition characterized by an elevated blood pressure (systolic and diastolic blood pressures of 140/90 mm Hg or more). It is an emerging public health concern alongside other NCDS in developing countries including Kenya partly due to globalization and industrialization. One of integral elements in management of hypertension is adherence to treatment to ensure optimal BP. Objectives: The purpose of this study was to assess factors that affect adherence to hypertension medication in Kiambu District Hospital. Methodology: A cross sectional study was conducted in 327 patients attending clinic at Kiambu District Hospital during the months of May, June, July and August, 2013. Those participating in the study were randomly sampled and included those above 18 years of age, those known to be hypertensive for more than one year and after obtaining an informed consent. Information was obtained by direct interview while adherence was assessed using Morisky Medication Adherence Scale. Knowledge on hypertension was done using 10 questions adopted from Susan et al (2005). BP was measured on each participant after a 5 minutes rest during the interview using sphygmomanometer machine. Data analysis was done using SPSS version 20. Chi-square test was used to establish associations between adherence and various factors while logistic regression was used to ascertain independent predictors of adherence to hypertension medication. Results: It was found that 62.4% of the respondents were fully adherent to treatment while only 48.3% of them had their BP controlled. Independent predictors of adherence were found to be monthly income, gender, number of antihypertensives and knowledge on hypertension and its treatment. There was a statistically significant association between adherence to treatment and BP control. Majority of the respondents were not knowledgeable on hypertension and its treatment (54.7%). Conclusion: Independent predictors of adherence to hypertension medication were found to be sex, monthly income, number of antihypertensives and knowledge of hypertension and its treatment. Recommendations: In order to avert morbidities and mortalities associated with hypertension, health care workers should ensure high quality management of the disease with emphasis on a strict compliance to treatment. They should formulate interventions tailored towards scaling up adherence in those subgroups of hypertensives found to be at risk of low adherence as informed by the findings of this study i.e. male patients, those of low socioeconomic status and those taking three or more antihypertensives. Health education on hypertension and adherence counselling by clinicians are critical aspects in the management of hypertension to ensure an improved adherence levels, optimal BP and consequently avert or reduce morbidities and mortalities associated with hypertension.