Medication adherence and blood pressure control in treated hypertensive patients: first follow-up findings from the PREDIcT-HTN study in Northern Bangladesh.

Introduction: Adherence to antihypertensive medication is crucial to control blood pressure (BP) and hypertension management outcomes. In Bangladesh, as in many other countries, poor adherence to medication represents a challenge to effective hypertension management. This study aims to investigate the prevalence and relationship between medication adherence and BP management among hypertensive patients in Bangladesh.

Methods: The PREDIcT-HTN study in Northern Bangladesh aims to evaluate major adverse clinical events in treated hypertensive patients. The study involves 2643 hypertensive patients from a medical center, with data collected through baseline information and yearly follow-ups until 2025. The first follow-up visit was conducted between January and March 2021. Following the 2020 ISH-global hypertension guideline, patients were classified as having controlled BP, grade-I, or grade-II uncontrolled BP. Patients were divided into three groups (good, moderate, and poor) based on their 9-item Hill-Bone medication adherence scale. A multinomial regression analysis was conducted to identify the association between medication adherence and BP control after adjusting potential confounders.

Results: Analysis of 2276 hypertensive patients (mean age 51.31 ± 11.58 years) revealed that 36.1% had grade-I and 24.2% had grade-II uncontrolled hypertension. Most patients (78%) displayed moderate adherence, and 15% showed poor medication adherence. Certain patient subgroups had higher rates of poor adherence: females (17.1%) compared to males (12.2%), rural residents (22.4%) compared to city-dwellers (12.2%), and newly diagnosed patients (17.2%) compared to those diagnosed 2-5 years earlier (12.6%). Multivariable analysis found a strong association between medication adherence and BP control. Compared to poor adherence, moderate adherence (relative risk ratio (RRR):0.50, 95%CI:0.36-0.68) and good adherence (RRR:0.56, 95%CI:0.35-0.91) were associated with better control. Increasing age, rural living, and uncontrolled hypertension were also linked. Comorbidities worsened BP control, and managing multiple medications contributed to poor adherence and grade-II hypertension in patients.

Conclusion: The high prevalence of uncontrolled hypertension in Bangladesh underscores the need for improved treatment strategies. Addressing medication adherence is essential for better BP control, with particular attention needed for women, rural residents, and newly diagnosed individuals. A comprehensive approach is warranted, including strategies to enhance adherence, early diagnosis, personalized treatment, and simplified medication regimens. These efforts align with the UN's 2030 SDGs, emphasizing targeted interventions for equitable healthcare access and outcomes.