1. Poor adherence to medication and salt restriction as a barrier to reaching blood pressure control in patients with hypertension: Cross-sectional study from 12 sub-Saharan countries
- Author
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Marie Antignac, Marie Cécile Perier, Liliane Mfeukeu Kuate, Carol Nhavoto, Dadhi M. Balde, Martin Dèdonougbo Houenassi, Yves N’da Kouakou N’goran, Adama Kane, Charles Kouam Kouam, Abdallahi Sidi Aly, Dominique Hounsou, Beatriz dos Santos Ferreira, Xavier Jouven, Florent Koffi, Michel Azizi, Emmanuel Limbole, Méo Stéphane Ikama, Ibrahim Ali Toure, Suzy Gisèle Kimbally-Kaki, Diane Macquart de Terline, Zouwera Sesso, Jean Philippe Empana, Kouadio Euloge Kramoh, Pierre-François Plouin, Jean Bruno Mipinda, Ibrahima Bara Diop, Kumar Narayanan, Samuel Kingue, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), and Université de Paris (UP)
- Subjects
Male ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Cross-sectional study ,[SDV]Life Sciences [q-bio] ,Black People ,Blood Pressure ,030204 cardiovascular system & hematology ,Medication Adherence ,Poor adherence ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Epidemiology ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Africa South of the Sahara ,Antihypertensive Agents ,Aged ,2. Zero hunger ,business.industry ,General Medicine ,Odds ratio ,Diet, Sodium-Restricted ,Middle Aged ,Confidence interval ,3. Good health ,Cross-Sectional Studies ,Treatment Outcome ,Blood pressure ,Health Care Surveys ,Hypertension ,Salt restriction ,Female ,Cardiology and Cardiovascular Medicine ,business ,Risk Reduction Behavior - Abstract
Summary Background Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and diet are the cornerstone of effective hypertension control. Aims To assess adherence to medication and salt restriction in 12 sub-Saharan countries, and to study the relationship between adherence and blood pressure control in patients with hypertension. Methods We conducted a cross-sectional survey in urban clinics in twelve sub-Saharan countries. Data were collected on demographics, treatment and adequacy of blood pressure control in patients with hypertension attending the clinics. Adherence was assessed by questionnaires completed by the patients. Hypertension grades were defined according to European Society of Cardiology guidelines. Association between adherence and blood pressure control was investigated using multilevel logistic regression analysis, adjusting for age, sex and country. Results Among the 2198 patients, 77.4% had uncontrolled blood pressure, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% were poorly adherent to both. Poor adherence to salt restriction (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.03–1.72), medication (OR 1.56, 95% CI 1.25–1.93) or both (OR 1.91 1.39–2.66) was related to uncontrolled blood pressure. Moreover, poor adherence to both medication and salt restriction was related to a 1.52-fold (95% CI 1.04–2.22), 1.8-fold (95% CI 1.22–2.65) and 3.08-fold (95% CI 2.02–4.69) increased likelihood of hypertension grade 1, 2 and 3, respectively. Conclusions High levels of poor adherence to salt restriction and medication were noted in this urban sub-Saharan study; both were significantly associated with uncontrolled blood pressure, representing major opportunities for intervention to improve hypertension control in sub-Saharan Africa.
- Published
- 2020