Journal of the American Heart Association · 2026
Global Prevalence of Adherence to Antihypertensives and Associated Moderating Factors Among Adults With Hypertension: A Meta-Analysis.
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Ngolombe Reymond, Chiona Burnett C, Khangamwa Singano Fikile, Sinyiza Frank, Chilinda Zizwani B, Wang Tsae-Jyy
Аннотация
BACKGROUND: Hypertension is a significant public health issue affecting over a billion adults worldwide with adherence to antihypertensives being crucial for achieving sustained blood pressure control and reducing cardiovascular morbidity and mortality. To extend previous evidence, we conducted a meta-analysis on global prevalence of adherence to antihypertensives among adults.
METHODS: A systematic search was conducted in Scopus, PubMed, Web of Science, Embase, and CINAHL. Pooled prevalence of antihypertensive medication adherence was estimated using generalized linear mixed-effects model in R software version 4.4.3. Cochran's Q, τ2, and I2$$ {I}^2 $$ statistics examined statistical heterogeneity with moderator analysis exploring sources of heterogeneity. Sensitivity analysis was analyzed using exact fixed-effects model.
RESULTS: A total of 123 studies with 1 052 445 adults with hypertension were included. Pooled global prevalence of adherence to antihypertensives was estimated at 58% (95% CI, 52%-63%), with 39% for high adherence, 29% for moderate adherence, and 35% for low adherence. Results for sensitivity analysis were 57.91% (95% CI, 57.81%-58.01%) with δ̂ being 24.3%. Prevalence across continents was 67% for Europe, 65% for South America, 60% for Africa, 56% for Asia, and 45% for North America. Adherence to antihypertensives was similar across low-income countries (61%), high-income countries (58), upper-middle-income countries (57%), and lower-middle-income countries (56%). In multivariate model, age and assessment tool only were significantly associated with medication adherence.
CONCLUSIONS: Globally, a large proportion of adults with hypertension exhibit moderate to low adherence to antihypertensive medications. Future studies should prioritize establishing consensus-based operational definitions and cutoff values to enhance adherence.
METHODS: A systematic search was conducted in Scopus, PubMed, Web of Science, Embase, and CINAHL. Pooled prevalence of antihypertensive medication adherence was estimated using generalized linear mixed-effects model in R software version 4.4.3. Cochran's Q, τ2, and I2$$ {I}^2 $$ statistics examined statistical heterogeneity with moderator analysis exploring sources of heterogeneity. Sensitivity analysis was analyzed using exact fixed-effects model.
RESULTS: A total of 123 studies with 1 052 445 adults with hypertension were included. Pooled global prevalence of adherence to antihypertensives was estimated at 58% (95% CI, 52%-63%), with 39% for high adherence, 29% for moderate adherence, and 35% for low adherence. Results for sensitivity analysis were 57.91% (95% CI, 57.81%-58.01%) with δ̂ being 24.3%. Prevalence across continents was 67% for Europe, 65% for South America, 60% for Africa, 56% for Asia, and 45% for North America. Adherence to antihypertensives was similar across low-income countries (61%), high-income countries (58), upper-middle-income countries (57%), and lower-middle-income countries (56%). In multivariate model, age and assessment tool only were significantly associated with medication adherence.
CONCLUSIONS: Globally, a large proportion of adults with hypertension exhibit moderate to low adherence to antihypertensive medications. Future studies should prioritize establishing consensus-based operational definitions and cutoff values to enhance adherence.