Special Conference Edition , November, 2019 http://dx.doi.org/10.4314/bajopas.v12i1.59S Bayero Journal of Pure and Applied Sciences, 12(1): 395 - 400 ISSN 2006 – 6996 ADHERENCE TO ANTIHYPERTENSIVE MEDICATIONS IN PATIENTS ATTENDING PUBLIC HOSPITALS IN KANO STATE , NIGERIA 1, 2* Umar Idris Ibrahim, Shafiu Mohammed 2, Abdulkadir Umar Zezi 3 and 4Basira Kankia Lawal 1. Department of Clinical Pharmacy and Pharmacy PractiPracticece,, Faculty of Pharmaceutical Sciences, Bayero University Kano, Nigeria. 2. Department of Clinical Pharmacy and Pharmacy PractiPracticece,, Faculty of Pharmaceutical Sciences, Ahmadu Bello University Zaria, Nigeria. 3. Department of Pharmacology and Therapeutics, FacultFacultyy of Pharmaceutical Sciences, Ahmadu Bello University Zaria, Nigeria. 4. Department of Clinical Pharmacy and Pharmacy ManagemManagement,ent, Faculty of Pharmaceutical Sciences, Kaduna State University, Nigeria. Correspondence author: [email protected] +2348038850147 ABSTRACT Hypertension is a chronic medical condition characterized by an elevated arterial blood pressure with increasing prevalence in developing countries including Nigeria. One of the integral elements in management of hypertension is adherence to medication and life- style modification. This study aimed to assess adherence level for anti -hypertensive medications among adult hypertensive patients attending public hospitals in Kano State, Nigeria. The study was a cross sectional prospective survey involving 600 pat ients from six public healthcare facilities selected by multistage sampling technique. Adherence status was assessed using Morisky medication adherence scale. Sociodemographic data and other factors that may influence adherence to hypertension medications were evaluated. Out of the 598 patients that participated in the study, only 178 (29.8%) have their BP controlled based on JNC8. Three hundred and thirty two (55.5%) out of 598 patients have good adherence, while 266 (45.5%) have poor adherence. Of the 178 patients who had good BP control, 120 (67.5%) have good adherence while 58 (32.5%) have poor adherence. BP control was significantly higher in those that adhered to antihypertensive medication compared with non -adhering patients (χ2 = 14.526; df = 1; p-va lue = < 0.001). Additionally, Chi -square test showed significant association between number of antihypertensives and blood pressure control. ( χ2=37.556 , df=3, p<0.001). The study established that 55.5% of the respondents have good adherence to their antihy pertensive medication while 29.8% had their BP controlled. Adherence and number of antihypertensive medication a patient is taking were found to have significant relationship with BP control. Keywords: Medication, adherence, hypertension, antihypertensive INTRODUCTION prevalence rates of hypertension in Africa and Hypertension (HTN), high or sustain increased Nigeria are 15% an d 22%, r espectively blood pressure (the systolic ≥ 140 mmHg and (Ekwunife and Aguwa, 2011). diastolic level ≥ 90 mmHg), is a worldwide Hypertension is a modifiable cardiovascular risk public health problem. It contributes to the factor for which there are available medications burden of cardiovascular diseases, stroke, and which are effective in regulating the raised blood renal failure leading to early mortality and pressure as well as preventing complications. disability (WHO, 2013). Global prevalence of However, the maximal beneficial effect of an adult h ypertensive patients was about 22% in appropriate trea tment plan can be achieved only 2014 and was estimated to account for more if patients strictly adhere to the medications and than 40% of the African adult population (Juliet lifestyle changes. The primary focus of Addo, 2007). In Sub Saharan Africa, it varied antihypertensive therapy is to achieve BP target from 6% to 48%, that is 74.7 million of < 140 per 90 mmHg for the general hypertensive individuals and projected to b e population and < 130 per 80 mmHg for special 68% (125.5 million) by 2 025 (Shona Dalal, high-risk population such as patients with 2011, Ogah and Rayner , 2013). The combined diabetes mellitus, renal disease and adverse 395 Special Conference Edition, November, 2019 cardiovascular events such as myocardial These patients are followed up in the hospital infarction and stroke (Chobanian et al. , 2003; for regular treatment and checkup depending on WHO, 2003). There are various antihypertensive high blood pressure control. Based on WHO drugs that have been shown to effectively methodology (WHO, 1993), 6 health care control blood pressure, thereby reducing the facilities were included in the study and in each attendant risk of cardiovascular morbidity and facility, 100 participants were randomly selected mortality. and assessed. Blood pressure control is multifactorial Study Design (Chobanian et al., 2003; WHO, 2003; Familoni et The study was a cross sectional prospective al., 2003) and some of these factors relate to the survey involving six public health care facilities patients, the health professionals and the selected by multistage sampling technique. List government. One of the patient-related factors and addresses of all registered health care is adherence to antihypertensive medication. facilities operating hypertension clinic in the Adherence is one of the challenges of State was obtained from the State Ministry of antihypertensive medication and is defined Health (SMoH). Based on the list, the State was conceptually as the degree to which the patient stratified into three using senatorial district as conforms to treatment as prescribed (Laurelea stratum. In north and south senatorial districts, and Roden, 2001) There is no ‘gold standard’ for one general hospital was selected, while in the precise measurement of adherence (Mallion & central zone, 3 general hospitals were selected Schmitt, 2001). However, several methods of (because it has the highest population and more measuring adherence to medication have been number of hospitals). In all the instances, described (Mallion and Schmitt, 2001; Bitter, selection was by simple random sampling using 1997; Averbach et al., 1997). Clinical measures balloting system. Also the only available teaching include the use of questionnaires for 30 days of hospitals was added to make-up the six facilities. self-reported (self-administered) therapy. Inclusion Criterion Pharmacological measures involve determination Hypertensive patients 18 years and above, of serum and urinary concentrations of drugs or patients on follow up appointments to the using biological markers integrated into the hospital, patients managed for hypertension for tablets. The pharmacological measures have a more than 6 months, patients consenting to higher sensitivity and specificity, but are not participate in the study. routinely used in clinical practice (Bitter, 1997). Exclusion Criterion Recently, the medication event monitoring Sick patients on the appointment day requiring system (MEMS) was introduced which is admission , pregnant hypertensive patients , basically the assessment of adherence using the individuals who were not capable of hearing and MEMS device which involves microprocessor- speaking , individuals with known mental based monitoring (Averbach et al., 1997). disorders However, the MEMS device is not readily Data Collection Tool and Procedure available in most facilities. Five pharmacy technicians were recruited as Generally, good adherence to medications is an research assistants and trained on the objectives important achievement in disease management, of the study as well as the data collection and it is crucial to decrease complications like instruments. cardiovascular related morbidity and mortality Adherence status was assessed using the (Donald et al., 2005; Brown and Bussell, 2011). Morisky medication adherence scale −8 which is However, to the best of our knowledge, a self-reporting method to determine adherence. particularly in the study areas, little is known It contains eight questions with seven closed about level of antihypertensive drug adherence dichotomous (yes/no) answers and one Likert among hypertensive patients. Therefore, this scale question. Each item measures specific study aimed to assess adherence level for anti- adherence behavior. The degree of adherence hypertensive medications among adult was determined according to the score resulting hypertensive patients attending public hospitals from the sum of all the correct answers (Morisky in Kano State Nigeria. et al., 1986). The questionnaire was translated to Hausa, the local language, for respondents MATERIALS AND METHODS who do not understand English. Also, Study Population and Sample Size sociodemographic data and other factors that The study population consists of adult may influence adherence to hypertensive hypertensive patients attending hypertension medication were evaluated. clinics and receiving treatment in the hospitals. 396 Special Conference Edition, November, 2019 The questionnaire was pretested at Murtala Data processing and analysis Muhammad Specialist Hospital using 25 After each clinic day, data collected were hypertensive respondents who were not entered into an excel spreadsheet where it was included in the final sample of the study. double checked by the principal investigator for Necessary adjustments to the questionnaires errors and any other inconsistencies. After data were made according to the findings of the pilot collection, the entire database was exported to study to improve the reliability of