Effect of Medication Adherence on Therapeutic Response to Antihypertensive Regimens in Newly Diagnosed Hypertensive Patients
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Abstract
Background: Hypertension remains a major contributor to cardiovascular morbidity, yet early blood pressure control is often limited by poor medication adherence and delayed treatment adjustment. Objective: To evaluate the effect of medication adherence on early therapeutic response among newly diagnosed hypertensive patients started on first-line antihypertensive therapy. Methods: This prospective cohort study was conducted in selected tertiary care hospitals of Karachi, Pakistan. Newly diagnosed adult hypertensive patients were followed for 12 weeks after initiation of first-line antihypertensive treatment. Patients were categorized as adherent or non-adherent based on medication-taking behavior during follow-up. Outcomes included blood pressure control at 12 weeks, systolic and diastolic blood pressure reduction, dose escalation, side effects, and therapeutic inertia. Results: Of 220 enrolled patients, 208 completed follow-up; 126 (60.6%) were adherent and 82 (39.4%) were non-adherent. Blood pressure control was achieved in 78 adherent patients (61.9%) compared with 24 non-adherent patients (29.3%) (OR 3.93, 95% CI 2.16–7.13; p < 0.001). Adherent patients had greater systolic reduction (18.6 ± 9.4 vs 8.9 ± 10.1 mmHg; p < 0.001) and diastolic reduction (11.2 ± 6.8 vs 5.1 ± 7.0 mmHg; p < 0.001). Dose escalation and therapeutic inertia were more frequent among non-adherent patients. Conclusion: Medication adherence was strongly associated with better early blood pressure control and fewer treatment adjustments.
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1. McEvoy JW, McCarthy CP, Bruno RM, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45(38):3912-4018. doi:10.1093/eurheartj/ehae178
2. Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension. J Hypertens. 2023;41(12):1874-2071. doi:10.1097/HJH.0000000000003480
3. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104. doi:10.1093/eurheartj/ehy339
4. Okonofua EC, Simpson KN, Jesri A, Rehman SU, Durkalski VL, Egan BM. Therapeutic inertia is an impediment to achieving the Healthy People 2010 blood pressure control goals. Hypertension. 2006;47(3):345-351. doi:10.1161/01.HYP.0000200702.76436.4b
5. Redón J, Coca A, Lázaro P, et al. Factors associated with therapeutic inertia in hypertension: validation of a predictive model. J Hypertens. 2010;28(8):1770-1777. doi:10.1097/HJH.0b013e32833b4953
6. Lebeau JP, Cadwallader JS, Aubin-Auger I, Mercier A, Pasquet T, Rusch E, et al. The concept and definition of therapeutic inertia in hypertension in primary care: a qualitative systematic review. BMC Fam Pract. 2014;15:130. doi:10.1186/1471-2296-15-130
7. Willock RJ, Fox KM, Kachroo S, McEwan P. Therapeutic inertia and treatment intensification. Curr Cardiol Rep. 2018;20(1):4. doi:10.1007/s11886-018-0943-1
8. Rea F, Corrao G, Merlino L, Mancia G. Initial antihypertensive treatment strategies and therapeutic inertia. Hypertension. 2018;72(4):846-853. doi:10.1161/HYPERTENSIONAHA.118.11308
9. Ali DH, Naureen F, Adam SI, et al. Therapeutic inertia in the management of hypertension in primary care. J Hypertens. 2021;39(6):1238-1245. doi:10.1097/HJH.0000000000002794
10. Darricarrere C, Pouche A, Mahabadi AA, et al. Uncontrolled blood pressure and therapeutic inertia in patients with treated hypertension: a real-world study. J Clin Hypertens (Greenwich). 2023;25(11):1044-1053. doi:10.1111/jch.14699
11. Wan KS, Kor CT, Hsu YC, et al. Treatment intensification and therapeutic inertia of hypertension in clinical practice. J Hum Hypertens. 2024. doi:10.1038/s41371-024-00967-9
12. Niriayo YL, Kumela K, Kassa TD, et al. Therapeutic inertia and contributing factors among patients with uncontrolled hypertension. BMC Cardiovasc Disord. 2024;24:579. doi:10.1186/s12872-024-04109-1
13. Mahmood S, Jalal Z, Hadi MA, et al. Non-adherence to prescribed antihypertensives in primary, secondary and tertiary healthcare settings in Islamabad, Pakistan: a cross-sectional study. Patient Prefer Adherence. 2020;14:73-85. doi:10.2147/PPA.S226364
14. Saqlain M, Riaz A, Malik MN, et al. Medication adherence and its association with health literacy and performance in activities of daily living among elderly hypertensive patients in Islamabad, Pakistan. Medicina (Kaunas). 2019;55(5):163. doi:10.3390/medicina55050163
15. Hashmi SK, Afridi MB, Abbas K, et al. Factors associated with adherence to anti-hypertensive treatment in Pakistan. PLoS One. 2007;2(3):e280. doi:10.1371/journal.pone.0000280
16. Qureshi NN, Hatcher J, Chaturvedi N, Jafar TH. Effect of general practitioner education on adherence to antihypertensive drugs: cluster randomised controlled trial. BMJ. 2007;335(7628):1030. doi:10.1136/bmj.39360.617986.AE
17. Yousuf FS, Khan MAA, Bibi R, Arif A, Arshad A, Almas A. Medication adherence in patients with uncontrolled hypertension and hypertensive crisis presenting to a hospital setting in Karachi, Pakistan. Cureus. 2023;15(1):e33995. doi:10.7759/cureus.33995
18. Noreen N, Bashir F, Khan AW, Safi MM, Lashari WA, Hering D. Determinants of adherence to antihypertension medications among patients at a tertiary care hospital in Islamabad, Pakistan, 2019. Prev Chronic Dis. 2023;20:E42. doi:10.5888/pcd20.220231
19. Khan A, Maqbool A, Khan AA, et al. Factors contributing to lack of adherence to antihypertensive medications among patients at Nishtar Hospital in Multan, Pakistan. Cureus. 2024;16(9):e69396. doi:10.7759/cureus.69396
20. Arshed M, Mujtaba H, et al. Prevalence and associated factors of adherence to antihypertensive medication: a nationwide cross-sectional study. BMC Public Health. 2025;25:21456. doi:10.1186/s12889-025-21456-6
21. Waris B, Butt NI, Afzal A, et al. Exploring knowledge of hypertension and treatment adherence in hypertensive patients from Lahore, Pakistan. Cureus. 2025;17(4):e81762. doi:10.7759/cureus.81762
22. Khan MU, Shah S, Hameed T. Barriers to and determinants of medication adherence among hypertensive patients attended National Health Service Hospital, Sunderland. J Pharm Bioallied Sci. 2014;6(2):104-108. doi:10.4103/0975-7406.129175
23. Almas A, Godil SS, Lalani S, Samani ZA, Khan AH. Good knowledge about hypertension is linked to better control of hypertension: a multicentre cross sectional study in Karachi, Pakistan. BMC Res Notes. 2012;5:579. doi:10.1186/1756-0500-5-579
24. Khan MN, Soomro N, Ashraf T, Naseeb K, Kumar R, Bhatti U, et al. Perceptions and practices towards medication non-adherence among hypertensive patients: an observational study. Cureus. 2019;11(10):e5917. doi:10.7759/cureus.5917
25. Kumar V, Rani M, Ahmed W, et al. Frequency of medication non-compliance in hypertensive patients presenting with stroke: a case-control study. Cureus. 2019;11(7):e5158. doi:10.7759/cureus.5158
26. Jafar TH, Hatcher J, Poulter N, et al. Community-based interventions to promote blood pressure control in a developing country: a cluster randomized trial. Ann Intern Med. 2009;151(9):593-601. doi:10.7326/0003-4819-151-9-200911030-00004
27. Basit A, Tanveer S, Fawwad A, Naeem N; NDSP Members. Prevalence and contributing risk factors for hypertension in urban and rural areas of Pakistan: a study from second National Diabetes Survey of Pakistan (NDSP) 2016-2017. Clin Exp Hypertens. 2020;42(3):218-224. doi:10.1080/10641963.2019.1619753
28. Elahi A, Ahmad T, Yousaf F, et al. Challenges of managing hypertension in Pakistan: a review. Curr Hypertens Rep. 2023;25(8):245-256. doi:10.1007/s11906-023-01242-3
29. Ahmad T, et al. Mobile health intervention for improving antihypertensive medication adherence in Pakistan: randomized controlled trial. J Med Internet Res. 2024;26:e50248. doi:10.2196/50248
30. Burnier M, Egan BM. Adherence in hypertension. Circ Res. 2019;124(7):1124-1140. doi:10.1161/CIRCRESAHA.118.313220
31. Poulter NR, Borghi C, Parati G, Pathak A, Toli D, Williams B, Schmieder RE. Medication adherence in hypertension. J Hypertens. 2020;38(4):579-587. doi:10.1097/HJH.0000000000002294
32. Hill MN, Miller NH, DeGeest S, et al. Adherence and persistence with taking medication to control high blood pressure. J Am Soc Hypertens. 2011;5(1):56-63. doi:10.1016/j.jash.2011.01.001
33. Krousel-Wood M, Holt EW, Joyce C, Ruiz R, Dornelles A, Webber LS, et al. Differences in cardiovascular disease risk when antihypertensive medication adherence is assessed by pharmacy fill versus self-report: the Cohort Study of Medication Adherence among Older Adults (CoSMO). J Hypertens. 2015;33(2):412-420. doi:10.1097/HJH.0000000000000382
34. Lachaine J, Petrella RJ, Merikle E, Ali F. Choices, persistence and adherence to antihypertensive agents: evidence from RAMQ data. Can J Cardiol. 2008;24(4):269-273. doi:10.1016/S0828-282X(08)70175-2
35. Schulz M, Krüger K, Schüssel K, Friedland K, Laufs U, Müller WE, Ude M. Medication adherence and persistence according to different antihypertensive drug classes: a retrospective cohort study of 255,500 patients. Int J Cardiol. 2016;220:668-676. doi:10.1016/j.ijcard.2016.06.263
36. Jung MH, Yang PS, Jang E, et al. Antihypertensive medication adherence and cardiovascular disease incidence and mortality: a nationwide population-based cohort study. J Am Heart Assoc. 2023;12(13):e029362. doi:10.1161/JAHA.123.029362
37. Gwadry-Sridhar FH, Manias E, Zhang Y, et al. A framework for planning and critiquing medication compliance and persistence research using prospective study designs. Clin Ther. 2009;31(2):421-435. doi:10.1016/j.clinthera.2009.02.005
38. Ruppar TM, Cooper PS, Mehr DR, Delgado JM, Dunbar-Jacob JM. Medication adherence interventions improve heart failure mortality and readmission rates: systematic review and meta-analysis of controlled trials. J Am Heart Assoc. 2016;5(6):e002606. doi:10.1161/JAHA.115.002606
39. Morrissey EC, Corbett TK, Walsh JC, Molloy GJ. Behavior change techniques in apps for medication adherence: a systematic review and meta-analysis. Am J Prev Med. 2016;50(5):e143-e146. doi:10.1016/j.amepre.2015.10.039
40. Reeves L, Robinson K, McClelland T, Adedoyin CA, Broeseker A, Adunlin G. Pharmacist interventions in the management of blood pressure control and medication adherence in hypertension: a systematic review of randomized controlled trials. J Clin Hypertens (Greenwich). 2021;23(3):650-660. doi:10.1111/jch.14140