# Psychosocial Determinants of Non-adherence to Antihypertensive Therapy: A Cross-Sectional Study in Pakistani Tertiary Care Hospitals

## TL;DR

This study explores why patients in Pakistan don't stick to their blood pressure medications, finding that stress, low income, and poor social support are key factors.

## Contribution

The study identifies psychosocial determinants of non-adherence to antihypertensive therapy in a Pakistani population using a large cross-sectional design.

## Key findings

- 40.3% of participants were nonadherent to antihypertensive therapy.
- High perceived stress, low social support, and low income were strongly associated with non-adherence.
- Forgetfulness and medication costs were the most common reasons for non-adherence.

## Abstract

Background

Hypertension is a major public health concern and leading cause of cardiovascular morbidity and mortality worldwide. Non-adherence to antihypertensive therapy is a global challenge, with adherence rates ranging from 50% to 70% in high-income countries and significantly lower in low- and middle-income countries (LMICs). Poor adherence contributes to inadequate blood pressure control and increases the risk of stroke, myocardial infarction, and other cardiovascular complications. Even though effective antihypertensive drugs are available, adherence is still not very good, especially in LMICs because of problems with money, healthcare access, and psychosocial factors.

Pakistan, like many LMICs, faces a high burden of hypertension; however, adherence rates remain underreported due to inconsistent methodologies and a lack of large-scale studies. Psychosocial factors, including perceived stress, social support, and health literacy, play a crucial role in influencing medication adherence; however, limited research has explored these determinants within the Pakistani population.

Objective

This study aimed to investigate the psychosocial determinants of non-adherence to antihypertensive therapy among patients receiving treatment at tertiary care hospitals in Pakistan. By identifying the key psychosocial factors affecting adherence, this study sought to provide evidence-based recommendations for improving hypertension management strategies.

Methods

A cross-sectional study was conducted at three tertiary care hospitals in Pakistan: Punjab Rangers Teaching Hospital, Lahore; Sharif Medical and Dental College, Lahore; and Lady Reading Hospital, Peshawar. In total, 360 patients with hypertension were recruited for this study. Medication adherence was assessed using a Medication Adherence Questionnaire (MAQ). Psychosocial determinants were evaluated using validated scales, including the Depression, Anxiety, and Stress Scale-21 (DASS-21) for perceived stress; the Multidimensional Scale of Perceived Social Support (MSPSS) for social support; and the Living with Medicines Questionnaire (LMQ) for health literacy. Chi-square tests and multivariate logistic regression were used for statistical analysis to find independent predictors of non-adherence.

Results

Among the 360 participants, 145 (40.3%) were classified as nonadherent. Significant associations were observed between non-adherence and lower educational levels (87, 60.0%; p < 0.001), low social support (62, 42.8%; p < 0.001), high perceived stress (127, 87.6%; p < 0.001), and lower monthly income (79, 54.5%; p = 0.002). The most commonly reported reasons for non-adherence were forgetfulness (67, 46.2%), medication costs (52, 35.9%), and perceived lack of necessity (32, 22.1%). Hospital-wise adherence rates varied significantly, with the highest adherence at Punjab Rangers Teaching Hospital (119, 66.1%) and the lowest at Lady Reading Hospital (38, 52.3%) (p = 0.028).

Conclusion

Non-adherence to antihypertensive therapy remains a significant public health concern, particularly in LMICs, such as Pakistan, where financial constraints, low education levels, and psychosocial stressors impact adherence. Taking these factors into account through patient education, financial aid programs, and psychosocial support systems may increase the number of people who stick to their treatment plans and lead to better management of hypertension.