Hypertension is a leading global public health challenge, affecting an estimated 1.28 billion adults worldwide, with a disproportionate burden observed in low- and middle-income countries (WHO, 2021). It significantly contributes to the global incidence of cardiovascular diseases, stroke, renal complications, and premature mortality. Although a range of effective antihypertensive therapies is available, achieving optimal blood pressure control remains elusive for many patients due to poor adherence to prescribed medication regimens.

Medication adherence—defined as the extent to which patients take their medications as prescribed—is vital for managing chronic conditions like hypertension. However, global adherence rates are suboptimal, typically ranging between 30% and 50% (Al-Ramahi, 2015) [1]. Studies from both high- and low-resource settings have identified medication non-adherence as a major barrier to hypertension control. For example, research from Saudi Arabia and Palestine demonstrated that socioeconomic status, forgetfulness, complexity of regimens, and side effects are key barriers to adherence (Algabbani & Algabbani, 2020; Al-Ramahi, 2015) [1, 2].

In rural populations, low health literacy and misbeliefs about hypertension contribute to reduced adherence, as shown by Kamran et al. (2014) [3], who applied the Health Belief Model to assess behavior. Similarly, findings from Ethiopia and Korea highlight the roles of follow-up care, patient-provider interaction, age, and pill burden in influencing adherence (Andualem et al., 2021; Lee et al., 2022) [4, 5]. A case-control study in Ethiopia further emphasized that patients with poor adherence had significantly lower knowledge and awareness about their treatment regimen (Getenet et al., 2019) [6].

Despite growing global evidence, there remains a paucity of recent, region-specific data from Indian outpatient settings. Given India’s diverse sociocultural and economic landscape, understanding the multifactorial determinants of medication adherence is essential for tailoring public health interventions.

This study aims to assess the level of medication adherence among patients with chronic hypertension and to identify key factors influencing adherence. Findings from this study can inform healthcare policies and patient education strategies to enhance chronic disease management and reduce the burden of uncontrolled hypertension.

Study Design:

This study employed a cross-sectional observational design to assess medication adherence and its determinants among patients with chronic hypertension.

Study Setting and Duration:

The study was conducted in the outpatient department of Pharmacology, in collaboration with the Department of General Medicine at Gandhi Medical College and Hospital, Secunderabad, Telangana. Data collection was carried out over a period of six months, from September 2023 to February 2024.

Study Population:

The study included adult patients aged 18 years and above who were diagnosed with chronic hypertension (≥6 months) and attending the outpatient clinic for routine follow-up. Patients with cognitive impairments, psychiatric illness, or those unwilling to participate were excluded.

Sample Size and Sampling Technique:

A total of 100 patients were selected using a convenient sampling method. Written informed consent was obtained from all participants prior to data collection.

Data Collection Tool:

Data were collected using a structured interview schedule which included:

Socio-demographic profile: age, gender, education, residence, and socioeconomic status.

Clinical profile: duration of hypertension, number of medications, presence of comorbidities.

Medication adherence: assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8), a validated self-report tool that categorizes adherence into high, medium, and low levels.

Data Analysis:

Data were entered into Microsoft Excel and analyzed using SPSS version 25. Descriptive statistics (mean, standard deviation, frequencies, and percentages) were used to summarize the data. Inferential statistics such as the chi-square test were applied to assess associations between medication adherence and potential determinants. A p-value < 0.05 was considered statistically significant.

Necessary permissions were obtained before study. Participation was voluntary and anonymity and confidentiality were strictly maintained throughout the study.

A total of 100 patients with chronic hypertension were enrolled in the study. The mean age of the participants was 56.4 ± 10.2 years. Of the total, 58% were female and 42% were male. The majority of patients (62%) were urban residents, while 38% resided in rural areas. Educationally, 70% had attained at least secondary-level education, and 30% had only primary or no formal education (Table 1).

Table 1: Demographic Characteristics of Participants (N = 100)

Medication Adherence Levels

Assessment using the Morisky Medication Adherence Scale (MMAS-8) revealed that 29% of the participants had high adherence to their prescribed antihypertensive regimen, 45% showed medium adherence, and 26% demonstrated low adherence levels (Table 2).

Table 2: Medication Adherence Levels (MMAS-8)

Figure No:1.Medication Adherence Levels (MMAS-8)

Determinants of Medication Adherence

Statistical analysis identified several significant determinants influencing adherence. Patients with higher educational attainment had significantly better adherence (p = 0.01). A longer duration of hypertension (>5 years) was associated with reduced adherence (p = 0.04). Patients on polypharmacy (taking more than three medications) and those with comorbidities such as diabetes had significantly lower adherence (p = 0.03 and p = 0.02, respectively). Notably, patients who reported clear and consistent communication from their physicians exhibited significantly higher adherence levels (p = 0.001). Forgetfulness was cited as a primary cause of non-adherence, particularly among those with low adherence, although not statistically analyzed (Table 3).

Table 3: Determinants of Medication Adherence

Reasons for Non-Adherence

Among the 71 patients identified as having either medium or low adherence, forgetfulness was the most frequently reported reason (48%), followed by side effects of medications (22%), financial constraints (18%), and the belief that medication was unnecessary when feeling well (12%) (Table 4).

Table 4: Reported Reasons for Non-Adherence (n = 71)

Figure No:2.Reported Reasons for Non Adherence

This cross-sectional observational study assessed medication adherence and its determinants among patients with chronic hypertension at Gandhi Medical College, Secunderabad. The findings revealed that only 29% of patients had high adherence to antihypertensive therapy, while 45% showed medium and 26% low adherence. These results are consistent with several studies conducted in similar populations across different regions, which report low-to-moderate adherence rates. For instance, a study conducted in Ethiopia found suboptimal adherence among hypertensive patients, emphasizing the ongoing global challenge in managing chronic hypertension effectively (Teshome et al., 2017) [7]. Similarly, Tilea et al. (2018) [8] documented inadequate adherence levels among Romanian adults, suggesting that the problem transcends geographic and healthcare system boundaries.

Educational status was significantly associated with adherence, with patients who had attained secondary or higher education showing better adherence. This supports findings by Venkatachalam et al. (2015) [9], who identified education as a key determinant of treatment compliance in rural South India. Health literacy enhances understanding of hypertension, its risks, and the importance of consistent therapy.

Longer duration of hypertension (>5 years) was associated with reduced adherence, potentially due to treatment fatigue, complacency, or declining motivation—an issue also noted in studies conducted among elderly patients (Krousel-Wood et al., 2009) [10]. Additionally, patients on polypharmacy regimens were more likely to exhibit poor adherence, aligning with observations from Varma et al. (2023) [11], who found that complex medication schedules negatively impact patient compliance in urban Indian populations.

Comorbidities such as diabetes were also linked to poor adherence, likely due to increased pill burden and prioritization of other medications. Effective doctor-patient communication significantly improved adherence, a finding echoed by Thirunavukkarasu et al. (2022) [12], who reported that consistent interaction with healthcare providers plays a critical role in shaping medication-taking behavior.

Among patients with medium or low adherence, forgetfulness was the most commonly reported reason, followed by side effects, financial challenges, and the belief that medications were unnecessary when symptoms subsided. These findings reflect barriers identified by Krousel-Wood et al. [10], who emphasized the psychological and behavioral aspects of non-adherence, including misbeliefs about disease severity.

This study highlights suboptimal medication adherence among patients with chronic hypertension, with only 29% demonstrating high adherence. Key determinants influencing adherence included educational status, duration of hypertension, polypharmacy, comorbid conditions, and the quality of doctor-patient communication. Forgetfulness, side effects, financial burden, and misbeliefs regarding medication necessity were major reasons for non-adherence. These findings emphasize the need for tailored interventions focusing on health education, simplified treatment regimens, and strengthened patient-provider communication. Implementing adherence-enhancing strategies such as reminder systems and counseling may significantly improve compliance and health outcomes. Addressing these factors is essential for better hypertension management and reducing the burden of cardiovascular complications.

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