Synthesis of the Literature

The United States Centers for Disease Control and Prevention and WHO in 2016 started the Global Hearts Initiative for maintenance directions to prevent and consider cardiovascular illnesses (WHO, 2020). According CDC percentage of adults aged 20 and over with hypertension calculated high blood pressure and/or taking antihypertensive medication 33.2% (2015-2016). Quantity of visits to physician offices with essential hypertension as the primary analysis is 32.8 million (CDC, 2017).

No adherence or not acquiring medications as recommended, to antihypertensive medications has related to uncontrolled hypertension. The instigators studied data from Health Styles 2010 to evaluate medication no adherence between adults with hypertension. The complete prevalence of hypertension was 27.4% and the prevalence of no adherence was 30.5% between hypertensive adult defendants (Tong et al.,2016). No adherence contributes to inadequate BP control, which has been associated with increased mortality rates. Examples of barriers to medication adherence include failure to remember to take medication, cost of medication, lack of health insurance, medication side effects, cultural beliefs, patient-physician relationship, depression and other cognitive dysfunction (working memory, processing speed), low health literacy, comorbidities, patient motivation, coping, financial barriers, and lack of social support (Al. Solami et al.,2015).

Nonadherence to antihypertensive medicines limits their effectiveness, increases the risk of adverse health outcome, and is associated with significant health care costs. The multiple causes of nonadherence differ both within and between patients and are influenced by patients’ care settings (Morrison et al.,2015). Known determinants of nonadherence to antihypertensive treatments may broadly be categorized as factors related to the patients and their familial and cultural context, condition, treatment, socioeconomic characteristics, and health professional/health care system (de Oliveira & Santos, 2018).

Components of sociocognitive and self-regulatory theory including attitude, perceived behavioral control, low self-efficacy, lack of perceived treatment benefits , perceived barriers, illness perceptions , beliefs about medicines and lack of social support are significantly associated with no adherence (Yoon et al., 2015). A considerable proportion of cardiovascular events could be attributed to poor adherence to antihypertensive medications. Adverse effects can be severe enough to affect adherence to antihypertensive medications (Gebreyohannes et al.,2019).

Patients state intentional and unintentional non-adherence. While unintended nonadherence is an unreceptive process whereby patients may be indifferent or forgetful about adhering to their antihypertensive medications, premeditated nonadherence, on the other hand, can be contemplated as an active process whereby patients intentionally stray from adhering to their antihypertensive medication conduct (Hacıhasanoğlu, 2016).

Adherence to antihypertensive treatment remainders is a key modifiable factor in the management of hypertension. The multidimensional nature of adherence and blood pressure (BP) control call for multicomponent, patient-centered interventions to improve adherence (Burnier, 2017). Favorable strategies to improve antihypertensive treatment adherence and BP manage comprise regimen simplification, decrease of out-of-pocket costs, use of allied health professionals for intervention delivery, and self-monitoring of BP. Research to understand the effects of technology-mediated interventions, mechanisms underlying adherence behavior, and sex-race differences in determinants of low adherence and intervention effectiveness may enhance patient-specific approaches to improve adherence and illness regulation (Peacock & Krousel-Wood, 2017).

About half of people with hypertension (HTN) have uncontrolled blood pressure. A significant cause of poor blood pressure control is inadequate medication adherence. Adherence to antihypertensive medications drops after initiating treatment, with about 10% of patients missing a dose on any given day and around half of HTN patients stopping medication by one year after prescription. Among patients with presumed resistant HTN, 43% to 65.5% of them are medication nonadherent. Patients with poor adherence to anti-hypertensives are at greater risk for coronary disease, cerebrovascular disease, and chronic heart failure. Poor medication adherence is associated with higher nondrug medical costs and constitutes a major barrier in reducing cardiovascular mortality (Conn et al.,2017).

Reduced adherence to antihypertensive medications is a major contributor to morbidity and mortality in patients with arterial hypertension. Approximations in the literature of the extent of poor adherence in patients with hypertension vary between around 20% and 80%, so it is difficult to be sure of the proportion of patients disturbed. Beneficial adherence to antihypertensive medications is important. Moreover, to achieve better blood pressure control and thus reduce adverse hypertension‐related outcomes, good adherence prevents unnecessary treatment escalation, additional appointments, investigations for secondary causes and even potentially invasive involvements (Mackenzie &MacDonald, 2018).

The significance of non-adherence is waste of medication, disease evolution, reduced functional capabilities, a lower quality of life, augmented use of medical resources such as nursing homes, hospital visits and hospital accesses. Economic studies divulge that poor adherence to prescribed regimens can result in serious health consequence which is supported by various revisions (Beena & Jimmy, 2018). Adherence to management, a public health issue, is of particular significance in chronic disease treatments. Primary care offers ideal settings for the effective care and management of these situations (Fernandez-Lazaro et al., 2019 ).

The usage of a single pharmacy allows patients to have a long-term relationship with pharmacists that fosters pharmacist-patient statement and therapy. Use of only one pharmacy to refill prescriptions also facilitates the pharmacist’s ability to track patients’ medication, improves patients’ follow up, and establishes a consistent medication evidence ( Beena & Jimmy, 2018). For persons with chronic diseases, managing of their conditions is important to diminish their impact, improve health results, prevent further disability, and reduce healthcare costs. Adherence to treatment, the amount to which patients are able to follow the approved recommendations for prescribed medications with healthcare provider, is a key component of chronic disease managing (Palladino et al., 2016)

References

Al. Solami., Fatmah,J,A., Correa-Velez, I,, & Xiang-Yu,H. (2015) Factors affecting antihypertensive medications adherence among hypertensive patients in Saudi Arabia. American Journal of Medicine and Medical Sciences, 5(4), pp. 181-189. Retrieved from DOI: 10.5923/j.ajmms.20150504.07

Beena, J.,& Jimmy, J. (2018). Patient Medication Adherence: Measures in Daily Practice, Retrieved from doi: 10.5001/omj.2011.38

Bernell, S., Howard, S,W. (2016). Use Your Words Carefully: What Is a Chronic Disease. Front Public Health. 2016;4:159. Retrieved from doi.org/10.3389/fpubh.2016.00159.

Boratas,S.,& Firat, K,H. (2018). Evaluation of medication adherence in hypertensive patients and influential factors. Retrieved from doi: 10.12669/pjms.344.14994

Burnier, M.,& Egan,BM. (2019). Adherence in Hypertension. A Review of Prevalence, Risk Factors, Impact, and Management

Burnier,M. (2017). Drug adherence in hypertension. Retrieved from https://doi.org/10.1016/j.phrs.2017.08.015

Carvalho, A,S.,& Santos,P. (2019). Medication Adherence In Patients With Arterial Hypertension: The Relationship With Healthcare Systems’ Organizational Factors. Retrieved from doi: 10.2147/PPA.S216091

CDC. (2017). Retrieved from https://www.cdc.gov/nchs/fastats/hypertension.htm

Conn, V,S.,Ruppar, T,M., Chase, D,J-A.,Enriquez, M.,& Cooper, PS. (2017). Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis. Retrieved from doi: 10.1007/s11906-015-0606-5

de Oliveira, AC.,& Santos, P. (2018). Hypertension: Drug Adherence and Social Factors. Retrieved from DOI: 10.23937/2474-3690/1510034

Drevenhorn,E. (2018). A Proposed Middle-Range Theory of Nursing in Hypertension Care. Retrieved from https://doi.org/10.1155/2018/2858253

Fernandez-Lazaro, C.I., García-González, J.M., Adams, D.P. et al. (2019). Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study. BMC Fam Pract 20, 132. Retrieved from https://doi.org/10.1186/s12875-019-1019-3

Fonju,P.,& Louie,K. (2018). Factors Associated with Medication Adherence among Hypertensive Adults in the North West Region of Cameroon. Retrieved from https://doi.org/10.15344/2394-4978/2018/278

Gebreyohannes, EA.,Bhagavathula,AS., Tamrat Befekadu ,A,T., Getaye ,T,Y.,&Tadesse Melaku,A,T. (2019). Adverse effects and non-adherence to antihypertensive medications in University of Gondar Comprehensive Specialized Hospital. Retrieved from doi: 10.1186/s40885-018-0104-6

Hacıhasanoğlu, A,R. (2016). Medication Adherence and Self-care Management in Hypertension. Retrieved from DOI: 10.5543/khd.2015.014

Mackenzie,IS.,&MacDonald,TM. (2018). Identifying poor adherence to antihypertensive medications in patients with resistant hypertension. Retrieved from doi: 10.1111/bcp.13806

Medication Adherence In Patients With Arterial Hypertension: The Relationship With Healthcare Systems’ Organizational Factors

Morrison,V,L.,Emily,A.F.,Clyne,W.,De Geest,S.,Kardas,P.,& Dyfing,A, (2015). Predictors of Self-Reported Adherence to Antihypertensive Medicines: A Multinational, Cross-Sectional Survey. Retrieved from https://doi.org/10.1016/j.jval.2014.12.013

Palladino, R,, Tayu, L, J., Ashworth, M., Triassi. M., & Millett, C. (2016): Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries. Age Ageing. Retrieved from https://doi.org/10.1093/ageing/afw044.

Peacock, E.,& Krousel-Wood, M.(2017). Adherence to Antihypertensive Therapy. Retrieved from doi: 10.1016/j.mcna.2016.08.005.

Tong, X.,Chu, E,K.,Fang, J.,Wall,HK.,&Ayala,C. (2016). Nonadherence to Antihypertensive Medication Among Hypertensive Adults in the United States. HealthStyles, 2010. Retrieved from doi: 10.1111/jch.12786

WHO. (2020). Retrieved from https://www.who.int/news-room/fact-sheets/detail/hypertension

Yoon,S,S.,Gu,Q.,Nwankwo,T.,Wright,JD.,Hong,Y.,& Burt,V. (2015). Trends in Blood Pressure Among Adults With Hypertension United States, 2003 to 2012. Retrieved from https://doi.org/10.1161/HYPERTENSIONAHA.114.04012

Figure 1

TREATMENT ADHERENCE IN PATIENTS WITH HYPERTENSION 14

Appendix A

Summary of Primary Research Evidence (this table may be single space)

Legend:

Level I: systematic reviews or meta-analysis Level II:  well-designed Randomized Controlled Trial (RCT)  Level III:  well-designed controlled trials without randomization, quasi-experimental  Level IV:  well-designed case-control and cohort studies  Level V: systematic reviews of descriptive and qualitative studies  Level VI:  single descriptive or qualitative study  Level VII: opinion of authorities and/or reports of expert committees

Appendix B

Summary of Systematic Reviews (SR) (this table may be single space)

Legend:

Level I: systematic reviews or meta-analysis Level II:  well-designed Randomized Controlled Trial (RCT)  Level III:  well-designed controlled trials without randomization, quasi-experimental  Level IV:  well-designed case-control and cohort studies  Level V: systematic reviews of descriptive and qualitative studies  Level VI:  single descriptive or qualitative study  Level VII: opinion of authorities and/or reports of expert committees

Appendix A

Summary of Primary Research Evidence

Citation Question

or

Hypothesis

Theoretical

Foundation

Research

Design

(include

tools) and

Sample

Size

Key

Findings

Recommendations/

Implications

Level of

Evidence

Legend:

Level I: systematic reviews or meta-analysis

Level II: well-designed Randomized Controlled Trial (RCT)

Level III: well-designed controlled trials without randomization, quasi-experimental

Level IV: well-designed case-control and cohort studies

Level V: systematic reviews of descriptive and qualitative studies

Level VI: single descriptive or qualitative study

Level VII: opinion of authorities and/or reports of expert committees