Adherence to antihypertensive drugs and its determinants in an urban setting

  • Mariwan H. Saka Department of Internal Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.
Keywords: Antihypertensive, Drugs, Adherence, Erbil, Urban Setting


Background and objective: Adherence to antihypertensive drugs is very important for controlling blood pressure and preventing its complications. This study aimed to assess the adherence level to antihypertensive drugs in adult hypertensive patients in Erbil city and examine its association with socio-demographic characteristics and access to medications.

Methods: A household survey was carried out in 20 quarters of Erbil city using a multi-stage sampling method. Adult patients known to have hypertension were identified. A questionnaire designed for this purpose was used to collect data about the socio-demographic and clinical characteristics, access to antihypertensive drugs, and adherence to drugs. 

Results: Of 373 study participants known to have hypertension, 87.9% were taking their antihypertensive treatment regularly, 5.9% were taking the treatment irregularly, while 6.2% were not taking any treatment. Around 77% of the patients were obtaining their drugs from private pharmacies, and the rest were getting them for free from the public hospitals. A statistically significant association was found between adherence to drugs, and increasing age, duration of having hypertension, and economic status.

Conclusion: The antihypertensive drug adherence among our sample was relatively good. Access to free drugs was limited. Drug adherence was significantly associated with increasing age, increased the duration of hypertension, and economic status. Similar studies need to be conducted in rural areas for comparison purposes.


Kaur P, Rao SR, Radhakrishnan E, Rajasekar D, Gupte MD. Prevalence, awareness, treatment, control and risk factors for hypertension in a rural population in South India. Int J Public Health 2012; 57(1):87–94.

Perkovic V, Huxley R, Wu Y, Prabhakaran D, MacMahon S. The burden of blood pressure-related disease: A neglected priority for global health. Hypertension 2007; 50:991–7.

Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365(9455):217–23.

WHO. World Health Statistics 2014 Report Geneva: WHO; 2014. (Accessed January 12, 2018, at stream/10665/112738/1/9789240692671 _eng.pdf ).

WHO. World Health Statistics 2011. Geneva: WHO; 2011.

WHO. Prevention of Cardiovascular Disease. Pocket Guidelines for assessment and management of cardiovascular risk. WHO Press; 2007.

Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. ESH/ESC Guidelines for the Management of Arterial Hypertension. Blood Press 2013; 22(4):193–278.

Pereira M, Lunet N, Azevedo A, Barros H. Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. J Hypertens 2009; 27:963–75.

Dragomir A, Côté R, Roy L, Blais L, Lalonde L, Bérard A, et al. Impact of adherence to antihypertensive agents on clinical outcomes and hospitalization costs. Medical Care 2010; 48(5):418–25.

Magadza C, Radloff S E, Srinivas SC. The effect of an educational intervention on patients' knowledge about hypertension, beliefs about medicines, and adherence. Res Social Admi Pharm 2009; 5(4):363–75.

De Geest S, Sabate´ E. Adherence to long-term therapies: evidence for action. Eur J Cardiovasc Nurs J Work Group Cardiovasc Nurs Eur Soc Cardiol 2003; 2(4):323.

Hashmi SK, Afridi MB, Abbas K, Sajwani RA, Saleheen D, Frossard PM, et al. Factors associated with adherence to anti-hypertensive treatment in Pakistan. PLoS One 2007; 2:e280.

Hsiao CY, Chang C, Chen CD. An investigation on illness perception and adherence among hypertensive patients. Kaohsiung J Med Sci 2012; 28:442–7.

Van der Feltz-Cornelis CM, Van Oppen P, Van Marwijk HW J, De Beurs E, Van Dyck R. A patient-doctor relationship questionnaire (PDRQ-9) in primary care: development and psychometric evaluation. Gen Hosp Psychiatry 2004; 26(2):115–20.

WHO. Adherence to Long-Term Therapies: Evidence for Action. Geneva: WHO; 2003.

Adidja NM. Adherence to anti-hypertensive treatment in the Buea Health District - a community based study. MD thesis. Buea: University of Buea; 2014.

Busari OA, Olanrewaju TO, Desalu OO, Opadijo OG, Jimoh AK, Agboola SM, et al. Impact of patients’ knowledge, attitude and practices on hypertension on compliance with antihypertensive drugs in a resource-poor setting. TAF Prev Med Bull 2010; 9(2):87–92.

Ahmed N, Abdul Khaliq M, Shah SH, Anwar W. Compliance to antihypertensive drugs, salt restriction, exercise and control of systemic hypertension in hypertensive patients at Abbottabad. J Ayub Med Coll Abbottabad 2008; 20(2):66–9.

Selcuk KT, Cevik C, Mercan Y, Koca H. Hypertensive patients' adherence to pharmacological and non-pharmacological treatment methods, in Turkey. IJCMPH 2017; 4(8):2648–57.

Shakor JK, Qader SS. Drug adherence among diabetic and hypertensive patients in association with demographic and healthy behavior. IJSR 2014; 3(12):1998–2003.

Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. JACC 2018; 71(19):e127–248.

Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: A systematic analysis for the global burden of disease study 2010. Lancet 2012; 380:2224–60.

Waeber B, Burnier M, Brunner H. How to improve adherence with prescribed treatment in hypertensive patients? J Cardiovasc Pharmacol 2000; 35:23–6.

Hadi N, Rostami-Gooran N. Determinant factors of medical compliance in hypertensive patients of Shiraz, Iran. Arch Iranian Med 2004; 7(4):292–6.

Alsolami F, Correa-Velez I, Hou X. Factors affecting antihypertensive medications adherence among hypertensive patients in Saudi Arabia. AJMMS 2015; 5(4):1–9.

Ismael DH, Qadir CS. Factor affecting treatment compliance of hypertensive patients in Erbil city. KJNS 2015; 5(2):1–8.

Kamran A, Ahari SS, Biria M, Malepour A, Heydari H. Determinants of patient's adherence to hypertension medications: Application of health belief model among rural patients. Ann Med Health Sci Res 2014; 4(6):9–7.

Mollaoglu M, Solmaz G, Mollaoglu M. Adherence to therapy and quality of life in hypertensive patients. Acta Clin Croat 2015; 54:438–44.

Akoko BM, Fon PN, Ngu RC, Ngu KB. Knowledge of hypertension and compliance with therapy among hypertensive patients in the Bamenda health district of Cameron: A cross-sectional study. Cardiol Ther 2017; 6:53–67.

Jokisalo E, Kumpusalo E, Enlund H, Halonen P, Takala J. Factors related to non-compliance with antihypertensive drug therapy. J Hum Hypertens 2002; 16:5–83.

How to Cite
Saka, M. (2019). Adherence to antihypertensive drugs and its determinants in an urban setting. Zanco Journal of Medical Sciences (Zanco J Med Sci), 23(3), 299-307.
Original Articles