To study the treatment compliance and adverse effects among hypertensive patients receiving treatment at Hypertension clinic, UHTC Pratap Nagar, Jodhpur, India.Design and Method:
A longitudinal study was conducted on 1036 hypertensive patients enrolled at Hypertension clinic, Pratap Nagar, Jodhpur, India. Patients attendees to the clinic during inception (Nov 2013) were selected for study purpose and quarterly follow-ups were done. The participants were asked about their socio-demographic status, therapy, side effects, and compliance with physicians’ instructions. In addition, 8 physicians reported: prescribing practices, drug side effects, and patient compliance for data corroboration. Noncompliance was defined as a ≥2-point decrease on the 8-item Morisky Medication Adherence Scale assessed during follow-ups after baseline. Multivariate regression analysis was done with P < 0.05 considered significant for variable effect under study.Results:
We observed an attrition rate of 9.2% (n = 96) participants in the study. The participant's mean age was 65.0 ± 5.6yrs (37–88 yrs); 67.9% were male; 51.9% illiterate and 39.0% belonged to lower socioeconomic strata (SES). 61.9% had hypertension for more than 10 years, and 48.0% were receiving multiple drug therapy. Over the 2 years of follow-up, 32.2% participants demonstrated noncompliance to antihypertensive medications. After multivariate adjustment noncompliance was significantly associated with: age (>60yrs, p = 0.003), uncontrolled BP (p = 0.025), illiteracy (p = 0.041), lower SES (p < 0.01) and adverse effect (p < 0.001). Drug adverse effects were reported among 19.01% participants; most frequently observed were dizziness (56.8%), cough (44.6%), oedema (28.4%) and rash/itch (17.7). Important predictors for changed therapy (41.21%) status were inadequate BP control (68.9%), adverse effects (11.9%), service dissatisfaction (7.0%) and cost (4.9%) etc.Conclusions:
Poor adherence to treatment is common in hypertensives mostly due to dissatisfaction with treatment & services and adverse effects. During follow-ups efforts shall be made to ensure full compliance and safe treatment by active patient engagement.