Published: 2022-07-27

Epidemiological correlates of adherence to anti-hypertensive treatment in primary health care setting of Ludhiana, Punjab

Sangeeta Girdhar, Anurag Chaudhary, Nahush R. Bansal, Prabhleen Kaur, Amanat Grewal


Background: There is an increasing burden of hypertension in India. The complications arising from hypertension mainly occur due to non-adherence to pharmacological and non-pharmacological interventions. Adherence to pharmacotherapy for hypertension varies from 43-88%. Various socio-demographic factors influence non-adherence. This study determined adherence to treatment among hypertensives and factors associated with non-adherence.

Methods: A cross-sectional study was conducted on hypertensive patients visiting OPD of an institutional urban health centre. A predesigned semi-structured questionnaire including socio-demographic profile, treatment-seeking behavior, adherence to medications, and lifestyle risk factors (smoking, intake of alcohol, junk food, and high salt diet) was applied. Reasons for non-adherence were also explored. Data were analyzed using SPSS 26 version.

Results: A total of 186 individuals: 113 females (60.8%) and 73 males (39.2%), participated in the study. The mean age of participants was 60.9±10.7 years. Adherence to anti-hypertensive treatment was witnessed in 68.3% of patients. The adherence was noticed significantly (p=0.001) more in literate than illiterate subjects. Further, the adherence was lower among smokers (25%) and alcohol consumers (43.75%) as compared to non-users (70.22% and 73.37%, respectively; p<0.01). Discontinuation of medicine on feeling well, forgetfulness, and unawareness were predominant reasons for skipping medications.

Conclusions: Non-adherence to the anti-hypertensives significantly adds to the disease burden. A deeper understanding of factors responsible for the non-adherence plays a pivotal role in addressing this issue and improving quality of life. Intensive health education and counseling of the patients is the need of the hour.


Hypertension, Urban population, Non-adherence, Contributing factors

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NCD Risk Factor Collaboration (NCD-RISC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet. 2017;389(10064):37-55.

WHO Global Report: Preventing chronic diseases: A vital investment. World Health Organization; Geneva: 2005. Available at: https://apps.who. int/iris/handle/10665/43314. Accessed on 5th June 2021.

Gupta R, Xavier D. Hypertension: the most important non-communicable disease risk factor in India. Indian Heart J. 2018;70:565-72.

Zhou D, Xi B, Zhao M, Wang L, Veeranki SP. Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III Linked Mortality Study. Sci Rep. 2018;20(8):9418.

Gupta R, Yusuf S. Towards better hypertension management in India. Indian J Med Res. 2014;139:657-60.

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. 2013;380:2224-60.

Sabaté E. Adherence to long-term therapies: evidence for action. Available at: Accessed on 5th June 2021.

Elliott WJ. What factors contribute to the inadequate control of elevated blood pressure? J Clin Hypertens (Greenwich). 2008;10:20-26.

Bhandari S, Sarma PS, Thankappan KR. Adherence to anti-hypertensive treatment and its determinants among urban slum dwellers in Kolkata, India.Asia Pac J Public Health. 2015;27:NP74-84.

Asgedom SW, Atey TM, Desse TA. Anti-hypertensive medication adherence and associated factors among adult hypertensive patients at Jimma University Specialized Hospital, southwest Ethiopia. BMC Res Notes. 2018;11:592.

Khanam MA, Lindeboom W, Koehlmoos TL, Alam DS, Niessen L, Milton AH. Hypertension: adherence to treatment in rural Bangladesh-findings from a population-based study. Glob health action. 2014;20(7):25028.

Tabassum N, Rao RLL. Factors associated with adherence to anti-hypertensive treatment among hypertensives in urban field practicing areas of Osmania medical college, Hyderabad. Int J Health Sci Res. 2017;7(12):31-9.

Misra P, Salve HR, Srivastava R, Kant S, Krishnan A. Adherence to treatment among hypertensive individuals in a rural population of North India. Indian J Comm Health. 2017;29(2):176-81.

Venkatachalam J, Abrahm SB, Singh Z, Stalin P, Sathya GR. Determinants of patient's adherence to hypertension medications in a rural population of Kancheepuram District in Tamil Nadu, South India. Indian J of Comm Med. 2015;40:33-7.

Ahmed S. Assessment of adherence to anti-hypertensive treatment among patients attending a health care facility in North India. Int J Res Med. 2015;4(1):117-24.

Mallya SD, Kumar A, Kamath A, Shetty A, Reddy SK, Mishra S. Assessment of treatment adherence among hypertensive patients in a coastal area of Karnataka, India. Int J Comm Med Public Health. 2016;3:1998-2003.

Kumaraswamy RC, Kauser MM, Jagadeesh MK, Kumar RU, Vagesh Kumar SR, Afreen A, et al. Study of determinants of non-adherence to anti-hypertensive medications in essential hypertension at a Teaching Hospital in Southern India. CHRISMED J Health Res. 2015;2:57-60.

Pandian S, Vijaykarthikeyan M, Umadevi R. A cross-sectional study on the compliance to anti-hypertensive drugs in a rural area. Int J Med Sci Public Health. 2020;9:414-18.

Kotian SP, Waingankar P, Mahadik VJ. Assessment of compliance to treatment of hypertension and diabetes among previously diagnosed patients in urban slums of Belapur, Navi Mumbai, India. Indian J Public Health. 2019;63:348-52.