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Original Research

. 2010; 1(4): 196-202

Predictors of uncontrolled hypertension and antihypertensive medication nonadherence

Manuel Morgado, Sandra Rolo, Ana Filipa Macedo, Luísa Pereira, Miguel Castelo-Branco.

Background: Although hypertension is, in most cases, a controllable major risk factor in the development of
cardiovascular disease, studies have demonstrated that hypertension remains poorly controlled in Portugal. Our
aim was to evaluate the covariates associated with poor blood pressure (BP) control in a Portuguese hypertensive
population. Patients and Results: We conducted a cross-sectional survey in a hospital hypertension outpatient
clinic, located in the Eastern Central Region of Portugal. Patients attending the clinic from July to September
2009 were asked to participate in a structured interview including medication adherence and knowledge about
hypertension. Eligible participants were all adults aged 18 or over with an established diagnosis of arterial
hypertension and had been on antihypertensive drug treatment for at least 6 months. Exclusion criteria were
dementia, pregnancy, and breastfeeding. Detailed clinical information was prospectively obtained from medical
records. A total of 197 patients meeting the inclusion criteria and consenting to participate completed the
interview. Of these, only 33.0% had their BP controlled according to the JNC 7 guidelines. Logistic regression
analysis revealed three independent predictors of poor BP control: living alone (OR = 5.3, P = 0.004),
medication nonadherence (OR = 4.8, P < 0.001), and diabetes (OR = 4.4, P = 0.011). Predictors of medication
nonadherence were: unawareness of target BP values (OR = 3.7, P < 0.001), a report of drug side effects (OR =
3.7, P = 0.002), lack of BP monitoring (OR = 2.5, P = 0.015) and unawareness of medication indications (OR
= 2.4, P = 0.021), and of hypertension risks (OR = 2.1, P = 0.026). Conclusions: Poor medication adherence,
lack of information about hypertension, and side effects should be considered as possible underlying causes of
uncontrolled BP and must be addressed in any intervention aimed to improve BP control.

Key words: Antihypertensives, blood pressure control, hypertension, medication adherence, Portugal

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