Therapeutic Adherence in Moroccan Hypertensive Patients: Influence of Socioeconomic Status and Fixed-Dose Combination Therapy.

INTRODUCTION

Hypertension represents a major public health challenge, contributing to the global health burden. Lifestyle modifications and pharmacotherapeutic interventions are the cornerstones in the management of hypertension. However, suboptimal adherence remains a critical impediment to achieving desired clinical outcomes, stemming from a complex interplay of socioeconomic factors, access to care, and affordability of medications. Therefore, the objective of this study was to assess adherence to lifestyle modifications and drug therapy and their associated factors.

METHODS

A monocentric cross-sectional study was conducted on 200 hypertensive patients from July 1st to October 30, 2022. Participants were selected using a consecutive sampling technique. Adherence to lifestyle modifications was assessed through questions filled in a data sheet, with consumption of salt and the DASH diet evaluated using a Food Frequency Questionnaire and the Hill-Bone Compliance to High Blood Pressure Therapy Scale, while medication adherence was assessed using the Morisky Medication Adherence Scale with 4 items (MMAS-4).

RESULTS

The overall adherence to lifestyle modifications was 39.8%, with good adherence to fruit and vegetable consumption at 59.5%, adherence to a low-salt diet at 43%, and physical activity at 24.5%. According to the MMAS-4, poor medication adherence was observed in 58.3% of our patients and was associated with advanced age (>60 years; p = 0.014), low socio-economic level (p = 0.012), and use of free-dose combination therapy (p = 0.001).

DISCUSSION: Our study demonstrates that poor adherence critically undermines hypertension control, while patient education and fixed-dose combination therapies improve outcomes. However, variability across populations and healthcare contexts limits generalizability and warrants further multicenter research.

CONCLUSION

The findings of this study indicate that therapeutic adherence among individuals with hypertension remains suboptimal, highlighting the need for a comprehensive, multifactorial strategy to address the diverse and intersecting determinants of nonadherence.