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Factors Associated with Antihypertensive Medication Non-Adherence: A Cross-Sectional Study Among Lebanese Hypertensive Adults

Authors Abbas H, Kurdi M, de Vries F, van Onzenoort HAW, Driessen JHM, Watfa M, Karam R

Received 15 November 2019

Accepted for publication 5 February 2020

Published 1 April 2020 Volume 2020:14 Pages 663—673


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Hanine Abbas,1– 3 Mazen Kurdi,1 Frank de Vries,2– 4 Hein AW van Onzenoort,2,5 Johanna HM Driessen,2– 4,6 Myriam Watfa,7 Rita Karam1,7,8

1Department of Chemistry and Biochemistry, Faculty of Sciences, Lebanese University, Beirut, Lebanon; 2Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre+, Maastricht, the Netherlands; 3Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands; 4Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, the Netherlands; 5Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands; 6NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; 7Quality Assurance of Pharmaceutical Products Department, Lebanese Ministry of Public Health, Beirut, Lebanon; 8Pharmacology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon

Correspondence: Rita Karam
Faculty of Sciences, Lebanese University, Section 1, Beirut, Lebanon
Tel +961 3 77 5061

Background: Poor adherence to antihypertensives is associated with negative outcome of the disease as well as loss of health-care resources. Addressing the epidemic of poor adherence requires identifying factors associated with this behaviour. The aim of this study is to describe adherence to antihypertensive medication among Lebanese hypertensive patients and to evaluate the association between socio-economic, patient- and conditions-related factors and non-adherence.
Methods: A cross-sectional study was carried out on adherence to antihypertensive medications covering all governorates of Lebanon. This study was conducted between February 2018 and January 2019 on a random sample of 1497 hypertensive patients. A face-to-face questionnaire was used to assess adherence to antihypertensive medication and its determinants according to the five World Health Organization (WHO) main categories. Logistic regression analysis was performed to test the adjusted association between the multiple exposure factors, and drug adherence data were collected by trained interviewers.
Results: Adherence to antihypertensive medications was reported by 1253 (83.7%) of the patients. After multivariate analysis, patients who tried to control their stress level (OR =  0.77, 95% CI [0.38– 0.95]), those who had normal BP readings (OR =0.49, 95% CI [0.18– 0.97]), and those who believed in the effectiveness of their treatment (OR =  0.31, 95% CI [0.14– 0.76]) had a significantly lower chance to exhibit non-adherence to their treatment. However, older patients (OR= 1.87, 95% CI [1.23– 2.21]), divorced/separated patients (OR= 2.14, 95% CI [1.31– 5.48]), married (OR=1.96, 95% CI [1.27– 3.90]), widowed (OR=2.11, 95% CI [1.62– 6.50]), obese patients (OR = 1.76, 95% CI [1.21– 1.94]), and patients who smoked hookah and cigarettes (OR = 2.62, 95% CI [1.17– 6.76]) were more likely to exhibit non-adherence.
Conclusion: Our study highlights the influence of factors such as old age, marital status, BMI and high level of emotional stress on non-adherence to medication in hypertensive patients. These determinants should be incorporated into adherence improving strategies.

Keywords: non-adherence, antihypertensive medications, patient-related factors, condition-related factor, Lebanon

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