Rate of Adherence to Antihypertensive Therapy and its Determinants among Iraqi Patients with Hypertension

Abstract

Background: Non-adherence to treatment is considered the main factor involved in poor control of the disease and a major obstacle in the management.
Objective: To determine the rate of adherence to antihypertensive therapy and to identify the socio-demographic and clinical factors that influence the adherence among Iraqi patients with hypertension.
Patients and Methods: A cross-sectional study conducted in Al-Najaf city during the period from July 2024 to May 2026. A total of 186 hypertensive patients who were met the inclusion criteria were enrolled. Participating patients were selected from two main primary healthcare centers (PHCCs) and outpatient clinic of Al-Najaf Teaching Hospital. The Medications Adherence Report Scale-5 (MARS-5) questionnaire was used to assess the adherence of our cohort patients.
Results: The mean age of the 186 patients was 51.1 (range: 26-74) years; 54.8% of the patients were males. The mean total MARS-5 score was 18.2 which fall within the nonadherence range. Among the 186 participants, 69.4% were adherent to antihypertensive therapy . Younger age, male gender, rural residence, higher education level, comorbidities, shorter disease duration, irregular consultation to physician polytherapy and uncontrolled blood pressure were significantly associated with lower adherence. Patients attributed the nonadherence to using multiple medications, high cost and unavailability of medication, fear of side effect, using an alternative therapeutic modality (herbal or other) and believe that the antihypertension treatment could be not effective.
Conclusions: The overall adherence of the participating patients was suboptimal and almost onethird of the patients were nonadherent. Lower adherence was associated with younger patient’s age, male gender, rural residence, higher education level, comorbidities, shorter disease duration, irregular consultation to physician polytherapy and uncontrolled blood pressure. Using multiple medications, high cost, unavailability , fear of side effect, using an alternative therapeutic modality and reliance on antihypertension treatment were the reported reasons for nonadherence.