Determinant Factors Affecting Adherence of Hypertensive Patients to

Taking Antihypertensive Drugs

A. A. Bagus Suryantara

, I Gede Putu Darma Suyasa

, Ni Putu Kamaryati

and Ida Ayu Ningrat Pangruating Diyu

Magister of Nursing Program, Faculty of Health, Institute of Technology and Health Bali, Indonesia

Bachelor of Nursing Program, Faculty of Health, Institute of Technology and Health Bali, Indonesia

Keywords: Adult, Hypertension, Medication Adherence.

Abstract: A key success factor of hypertension management is adherence to taking hypertensive medications. However,

little research has been done to explore determinant factors of hypertension management in adult patients.

The study aimed to determine factors that affect adherence of hypertensive patients to taking antihypertensive

drugs. This study was a descriptive-analytic study with a cross-sectional approach. The research sample was

133 hypertensive patients from a Primary Healthcare Center selected using a simple random technique.

Inclusion criteria applied in sample selection were patients who visited Primary Healthcare Centers and were

aged 18 years and above. Ethical clearance for this study was granted by ITEKES Bali Research Ethics

Committee. Data collection was conducted in May 2022 using a valid and reliable questionnaire. Chi-square

analyses were conducted for bivariate analyses. Variables with a p-value of < 0.25 were further analyzed with

logistic regression. The results of bivariate analysis showed age, education, occupational, period of suffering,

motivation, and family support had a significant influence on adherence to taking antihypertensive drugs (p

< 0.05). The logistic regression test analysis showed that family support (p < 0.001; AOR: 14.050; 95% CI:

4.045-48.796) and age (p < 0.001; AOR: 0.038; 95% CI: 0.011 - 0.127) were significant determinant factors

affecting adherence to taking antihypertensive drugs. Health care professionals need to continue supporting

and educating families about hypertensive care.

1 INTRODUCTION

Hypertension is a major health problem.

Hypertension is an increase in systolic blood pressure

of about 140 mmHg and diastolic blood pressure of

about 90 mmHg. Hypertension shows no specific

symptoms, and thus being alert to this disease will

prevent hypertension. With the invisible symptoms,

hypertension is often called the silent killer

(American Heart Association, 2020).

Based on the report of the Basic Health Research

(2018), the number of people with hypertension in

Indonesia who routinely took antihypertensive drugs

(54.40%) was greater than those who did not take

medication regularly (32.27%) and did not take

medication at all (13.33%). Some areas of Bali

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Province show percentages of people who adhered to

taking antihypertensive drugs. For example, Badung

Regency (41.75%) had 2,224 compliant patients;

Karangasem Regency (40.71%) showed 1,340

adhered patients, and Jembrana Regency (32.54%)

showed 910 compliant patients. (Riskesdas, 2018).

Data from the Badung Regency Health Office present

the highest prevalence of hypertension in the Mengwi

sub-district with 2,293 patients, followed by South

Kuta sub-district with 2,212 patients. Meanwhile, the

lowest of hypertension cases was found in the Petang

sub-district with 597 patients. The working area of

Mengwi I Primary Healthcare Center had the highest

number of hypertension cases amounting to 987

people (Dinkes Kabupaten Badung, 2020).

Suryantara, A., Suyasa, I., Kamaryati, N. and Diyu, I.

Determinant Factors Affecting Adherence of Hypertensive Patients to Taking Antihypertensive Drugs.

DOI: 10.5220/0011940700003576

In Proceedings of the 2nd Bali Biennial International Conference on Health Sciences (Bali BICHS 2022), pages 76-81

ISBN: 978-989-758-625-5

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

People with hypertension should take medication

every day regardless pain and symptoms. Treatment

adherence is aimed to control blood pressure of

patients and avoid complications (Utami &

Raudatussalamah, 2017). Uncontrolled consumption

of antihypertensive drugs can result in therapy

failures, one of which is unstable blood pressure,

complications and organ damage (Nurmainah et al.,

2014).

Research conducted by Pramana (2019), revealed

that age, gender, level of education, therapy, and

motivation affect adherence to taking

antihypertensive drugs. However, in a study

conducted by Handayani et al. (2019), age, gender,

occupation, motivation, family support, and

education have no relationships with adherence to

taking antihypertensive drugs. With these different

results, this study was focused on the identification of

determinant factors associated with adherence to

taking antihypertensive drugs.

2 SUBJECTS AND METHODS

This current study was quantitative with a cross-

sectional design. The research was conducted in May

2022 at the Mengwi I Primary Healthcare Center. The

population of this study was hypertensive patients

that were selected through the simple random

sampling with a sample size calculation

recommended by the World Health Organization. It

reached a total sample of 133 respondents after

calculation. The inclusion criteria of respondents in

this study were patients who were medically

diagnosed with hypertension by doctors and

hypertension patients who visited a primary

healthcare center for seeking treatment.

In data collection phase, this study used a

questionnaire consisting of the demographic

characteristics of the respondents, a motivation

questionnaire (Banifi, 2017), and a family support

questionnaire (Nursalam, 2015); additionally, the

MMAS-8 (Reynolds, 2012) questionnaire was used

to assess medication adherence. All statistical

analyses in this study were processed in SPSS version

21.0. Bivariate statistical analysis was performed

using the chi-square test. Multivariate binary logistic

regression was performed by inserting a predictor

with a p-value of < 0.25. This study was given an

ethical permission by the ITEKES BALI Ethics

Committee with the No. 03.0286/KEPITEKES-

BALI/III/2022 before data collection.

3 RESULTS

Table 1: Respondents’ Characteristics (n = 133).

Characteristics n %

Non-elderl

71 53.4

Elderl

62 46.6

Gender

Female 80 60.2

Male 53 39.8

Level of Education

h 93 54.9

Low

Occupational

Unemployment

45.1

69.9

30.1

Period of sufferin

ears 91 68.4

≥5 years 42 31.6

Motivation

High 70 52.6

Low 63 47.4

Family Support

Good

Poor

66.2

33.8

Adherence to taking

medication

Adherent

Nonadherent

59.4

40.6

Table 1 shows that most of the respondents are

non-elderly (53.4%) and women (60.2%). A half of

the respondents obtain higher education level

(54.9%), and most of the respondents had

unemployment status (69.9%). The majority of

respondents develop hypertension for less than five

years (68.4%) and have high motivation (52.6%).

Respondents mostly receive family support (66.2%),

and they took antihypertensive drugs regularly (59.4

%).

Determinant Factors Affecting Adherence of Hypertensive Patients to Taking Antihypertensive Drugs

Table 2: Relationships between respondents’ characteristics, motivation, and family support with adherence to taking

hypertension medication (n = 133).

Variable

Adherence to Taking

Antihypertensive Drugs

Total

P Value OR (CI 95%)

Nonadherent Adherent

f % f % f %

Age <.001 .020 (0.007-0.060)

Non-elderl

5 9.3 66 83.5 71 53.4

Elderl

49 90.7 13 16,5 62 46.6

Gender 0.862 1.065 (0.525-2.157)

Female 32 59.3 48 60.8 80 60.2

Male 22 40.7 31 39.2 53 39.8

Level of Education <.001 34.088 (12.640-91.929)

High 7 13.0 66 83.5 73 54.9

Low 47 87.0 13 16.5 60 45.1

Occu

ational <.001 7.795

(

2.806-21.652

)

Unemployment 49 90.7 44 69.9 93 69.9

Employee 5 9.3 35 44.3 40 30.1

Period of

sufferin

0.002 3.578 (1.543-8.341)

<5 Years 45 83.3 46 58.2 91 68.4

≥5 Years 9 16.7 33 41.8 42 31.6

Motivation <.001 5.958 (2.774-12.798)

Hight

15 27.8 55 69.6 70 52.6

Low

39 72.2 24 30.4 63 47.4

Family Support <.001 31.633 (11.367-88.029)

Good 15 27.8 73 92.4 88 66.2

Poor 39 72.2 6 7.6 45 33.8

In Table 2, this study presents that age (p =<

0.001), gender (p = 0.862), level of education (p =<

0.001), occupational (p =< 0.001), period of suffering

(p = 0.002), motivation (p =< 0.001), and family

support (p =< 0.001).

Table 3: Factors most related to adherence to taking antihypertensive drugs (n = 133).

Variables B S.E. Wald df P Value Adjusted

Odds Ratio

OR (CI 95%)

Lower Upper

Age -3.267 .615 28.216 1 <.001 .038 .011 .127

Level of

education

-.18.215

28162.1

.000 1 0.099 .000 .000

Ocupational

.350 .945 .137 1 0.711 1.418 .223 9.038

Period of

suffering

-786 .829 .717 1 0.397 .456 .074 2.812

Motivation

-.604 .639 .759 1 0.384 .547 .141 2.126

Family

ort

2.643 .635 17.306 1 <.001 14.050 4.045 48.796

Table 3 demonstrates that age (p =< 0.001) and

family support (p =< 0.001) were the most dominant

factors influencing adherence to hypertensive

medication. Level of education (p = 0.099),

occupational (p = 0.711), period of suffering (p =

0.397), and motivation (p = 0.384) are insignificant

factors that influenced adherence to hypertensive

medication.

Bali BICHS 2022 - The Bali Biennial International Conference on Health Sciences

4 DISCUSSION

4.1 Age and Adherence to Taking

Antihypertensive Drugs

This study shows age had a significant relationship

with adherence to taking antihypertensive drugs.

Around half of the respondents (53.4%) were non-

elderly aged <60 years old. They were more obedient

to taking antihypertensive drugs than the elderly

respondents (≥ 60 years). Research conducted by

Samsudin and Maharani (2020) found a relationship

between age and adherence to taking antihypertensive

drugs. Non-elderly have more stable organs and

sensory to respond to the treatment procedures.

However, age does not affect one’s compliance

with hypertensive medication. Elderly tends to

experience physical and cognitive decline which can

reduce their self-management in taking

antihypertensive drugs (Wahyudi et al., 2017).

4.2 Gender and Adherence to Taking

Antihypertensive Drugs

The results of this study show that gender did not

have a significant relationship with adherence to

taking antihypertensive drugs. This indicates that

both women and men have an awareness of health

regardless of their gender. Research conducted by

Puspita (2017) found a similar finding to this study.

Both women and men are equally concerned

about their health because they have the same social

equality or social status. The social status includes

education, which was equally distributed among male

and female respondents. Therefore, both women and

men have the same understanding and awareness of

adherence to hypertensive medication (Liberty et all.,

2018).

4.3 Level of Education and Adherence

to Taking Antihypertensive Drugs

Given the analysis of education variable, this study

found education level was significantly related to

compliance with medication. Most of the respondents

were highly educated (54.9%) and were more

obedient to hypertensive medication than low-

educated respondents. Research by Mardiana et al.

(2021) is aligned with this current study. Education

level is one of the factors that can affect one’s

adherence to treatment. A person who has higher

education level will likely understand the purpose of

the treatment, reinforcing their compliance with the

treatment.

Education level becomes the basic capital in

decision-making. Once a person holds higher

education degree, he/she will receive and understand

information at hand. As a result, she/he can develop

their self-management and awareness to comply with

medication (Pamungkas, 2015; Pratama & Ariastuti,

2016; Mahardika et al., 2021).

4.4 Occupation and Adherence to

Taking Antihypertensive Drugs

Besides age and education level, occupation was also

found to be significantly related to compliance with

medication. This study shows that most unemployed

respondents were more obedient to taking

antihypertensive drugs than employed ones.

According to previous research by Nurhani et al.

(2020), someone who works tends to have less time

to schedule their medication compared to someone

who does not work (Rajasati et al., 2018). Doctor’s

recommendations are not taken for further medication

as working patients infrequently visit primary

healthcare centers.

4.5 Period of Suffering and Adherence

to Taking Antihypertensive Drugs

The results of this study show that the period of

suffering had a significant relationship with

adherence to taking antihypertensive drugs. In this

study, the majority of the respondents (68.4%)

suffered from hypertension for <5 years and were

more compliant to taking antihypertensive drugs than

those who suffered from hypertension for >5 years. A

similar finding is stated in research conducted by

Balqis and Nurmaguphita (2018). Curiosity and

strong motivation to recovery make respondents

improve their awareness and efforts to comply with

the recommendations and prohibitions from

incompliance with medication (Wahyudi et al., 2018).

4.6 Motivation and Adherence to

Taking Antihypertensive Drugs

The results of this study show that a significant

relationship was found between motivation and

adherence to taking antihypertensive drugs. The

majority of respondents (52.6%) had high motivation

and were more likely compliant with taking

antihypertensive drugs compared to those who had

low motivation. Research conducted by Hanum et al.

(2019) reveals that intrinsic motivation i.e., hope and

Determinant Factors Affecting Adherence of Hypertensive Patients to Taking Antihypertensive Drugs

interest is the key factor for patient recovery and

compliance with treatment. Motivation comes from

family support (Nuratika et al., 2020).

4.7 Family Support and Adherence to

Taking Antihypertensive Drugs

Family support turns out to be associated with

adherence to taking antihypertensive drugs. The

results show that the respondents (66.2%) had high

family support and mostly adhered to medication

compared to respondents who had low family

support. Family support has a very important role to

provide emotional support and informational support

(Serinadi et al., 2021). Determining individual health

beliefs and values needs to be included into treatment

programs (Widowati, 2019). According to Kamaryati

and Malathum (2020), family support is very

effective in increasing medication adherence. Family

support can provide emotional and financial support

such as peace and compliance with medication.

Someone who has high family support will provide

peace and reduce burden of the patients. Family

support can control self-confidence in problem-

solving and self-management in medication

(Ningrum & Sudiasih, 2019).

5 CONCLUSION

Family support and age are the determining factors

that influence adherence to taking antihypertensive

drugs. A person with high family support has a

greater chance of adhering to taking antihypertensive

drugs than respondents with low family support.

Health workers need to provide support and education

about hypertensive treatment to families.

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Determinant Factors Affecting Adherence of Hypertensive Patients to Taking Antihypertensive Drugs