Treatment adherence among adult hypertensive patients: a cross-sectional retrospective study in primary care in Romania

Abstract

Purpose: This study was performed to elucidate the level of adherence to antihypertensive treatment in adult subjects attending a family medicine clinic in a city in central Romania.

Patients and methods: A cross-sectional, retrospective study was performed on a cohort of hypertensive adults. A total of 525 participants were selected from 1,714 adults attending a single urban family medicine practice. Assessment of adherence to therapy was performed by a chart review of prescription and clinical records over a 4-year study period.

Results: The results showed that 69.8% of the patients had high adherence (>80% with therapy); 20.3% had medium adherence (20%-79%); and 9.9% had low adherence (<20%). A positive association was found (p = 0.01) between low adherence and male gender. A significant positive association (p = 0.02) was found between total cardiovascular risk and level of adherence. We found that 54.7% of the high adherence subjects had well-controlled blood pressure, and chronic kidney disease was associated with high adherence to therapy (p = 0.03). Antihypertensive regimens administered as fixed-dose combinations were positively associated with high adherence (p = 0.001). Subjects who had their antihypertensive regimen adjusted to a new drug class during the study period showed enhanced adherence compared to subjects treated with an unchanged regimen (p = 0.001).

Conclusion: This is the first published study assessing adherence to antihypertensive therapy in family medicine practice in Romania. It presented data derived from a primarily urban setting and targeted a geographical area where the prevalence of hypertension has increased continuously. Female gender, age, presence of cardiovascular risk factors, defined cardiovascular disease, chronic renal impairment, and good control of hypertension were positively associated with high adherence. The results provide insights to guide further strategies to improve adherence and indirect methods for blood pressure management strategies.

Keywords: Eastern Europe; blood pressure; family medicine; hypertension; prescription.

Figure 1

Participants’ BP control/risk factors – uncontrolled BP. Notes: The red line establishes the cut-off value for controlled and uncontrolled BP. The blue circles represent the individual BP value for each and every patient. The black line represents the trend in the systolic BP. Abbreviation: BP, blood pressure.

Figure 2

Persistence with antihypertensive drug classes. Abbreviations: ARB, angiotensin receptor blocker; BB, beta-blockers; CCB, calcium channel blocker; ACE, angiotensin-converting enzyme inhibitor.