The Impact of Medication Adherence on Quality of Life in Hypertensive Patients: A Cross-Sectional Analysis

Year 2025, Volume: 12 Issue: 3, 641 - 655, 31.12.2025

Birol Yetim

https://doi.org/10.21020/husbfd.1715486

Abstract

Objectives: The main objective of the study is to examine the medication adherence levels of hypertensive patients and to evaluate the effect of adherence on their quality of life.
Materials and Methods: The research was conducted with 341 patients diagnosed with hypertension who visited a family health center in Erzincan between January and April 2025. Data were collected by using demographic information forms, the General Medication Adherence Scale, and WHOQOL-BREF. Descriptive statistics, t-tests, ANOVA, and multiple regression analysis were used for data analysis.
Results: The results of the study revealed the patients' medication adherence level was 1.86, and the quality of life score was 43.62 out of 100. The most problematic area in medication adherence was the patient behavior-related adherence subscale, while the least issues were observed in economic-related non-adherence. The lowest score for quality of life was found in the physical health domain. Statistical analyses indicated that the levels of medication adherence and quality of life significantly differed according to age, educational level, income, disease duration, and the number of comorbidities (p<0.05). Especially, individuals in the 45-64 age group had higher levels of both medication adherence and quality of life compared to patients aged 65 and above. According to the regression analysis, medication adherence significantly predicted the quality of life (p<0.05).
Conclusion: From this perspective, the findings of this study are guiding for the development of health policies and the planning of personalized healthcare services.

Keywords

hypertension , medication adherence , quality of life , health behaviors

References

• Algabbani, F., & Algabbani, A. (2020). Treatment adherence among patients with hypertension: findings from a cross-sectional study. Clinical Hypertension, 26.
• Amer, M., Raza, A., Riaz, H., Sadeeqa, S., & Sultana, M. (2019). Hypertension-related knowledge, medication adherence and health-related quality of life (HRQoL) among hypertensive patients in Islamabad, Pakistan. Tropical Journal of Pharmaceutical Research, 18(5), 1123-1132.
• Aydın, Z., & Öztürk, S. (2014). Hipertansiyon tedavisinde güncel yaklaşımlar. Haseki Tıp Bülteni, 52(4), 251-255.
• Azar, F., Solhi, M., & Chabaksvar, F. (2020). Investigation of the quality of life of patients with hypertension in health centers. Journal of Education and Health Promotion, 9.
• Barbareschi, G., Sanderman, R., Leegte, I. L., Van Veldhuisen, D. J., & Jaarsma, T. (2011). Educational level and the quality of life of heart failure patients: a longitudinal study. Journal of Cardiac Failure, 17(1), 47-53.
• Bayliss, E. A., Bayliss, M. S., Ware, J. E., & Steiner, J. F. (2004). Predicting declines in physical function in persons with multiple chronic medical conditions: what we can learn from the medical problem list. Health and Quality of Life Outcomes, 2, 1-8.
• Beevers, G., Lip, G. Y., & O'Brien, E. (2001). The pathophysiology of hypertension. Bmj, 322(7291), 912-916.
• Burnier, M., & Egan, B. M. (2019). Adherence in hypertension: a review of prevalence, risk factors, impact, and management. Circulation Research, 124(7), 1124-1140.
• Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., & Izzo Jr, J. L. (2003). The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. Jama, 289(19), 2560-2571.
• Dickinson, H. O., Mason, J. M., Nicolson, D. J., Campbell, F., Beyer, F. R., Cook, J. V., ... & Ford, G. A. (2006). Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. Journal of Hypertension, 24(2), 215-233.
• Dragomir, A., Côté, R., Roy, L., Blais, L., Lalonde, L., Bérard, A., & Perreault, S. (2010). Impact of adherence to antihypertensive agents on clinical outcomes and hospitalization costs. Medical Care, 48(5), 418-425.
• Eser, E., Fidaner, H., Fidaner, C., Eser, S. Y., Elbi, H., & Göker, E. (1999). WHOQOL-100 ve WHOQOL-BREF’in psikometrik özellikleri. Psikiyatri Psikoloji Psikofarmakoloji (3P) Dergisi, 7(Suppl 2), 23-40.
• Kamble, G., & Srinivas, S. P. (2019). Impact of asymptomatic hypertension on left and right ventricular functions by echocardiography. National Journal of Physiology, Pharmacy and Pharmacology, 9(12), 1234-1238.
• Karadamar, N. (2022). Kronik hastalığı olan hastalarda genel ilaç uyumu ölçeği'nin Türkçe geçerlik ve güvenirlik çalışması. Yüksek Lisans Tezi. İstanbul Medipol Üniversitesi.
• Krousel-Wood, M., Joyce, C., Holt, E., Muntner, P., Webber, L. S., Morisky, D. E., & Re, R. N. (2011). Predictors of decline in medication adherence: results from the cohort study of medication adherence among older adults. Hypertension, 58(5), 804-810.
• Law, M. R., Morris, J. K., & Wald, N. J. (2009). Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. Bmj, 338.
• Lee, J., & Lee, K. (2023). Treatment burden mediates the association between the number of comorbidities and health-related quality of life in young and middle-aged patients with hypertension and comorbidities. European Journal of Cardiovascular Nursing, 22(Supplement_1), zvad064-097.
• Lee, M., & So, E. (2012). Impact of Hypertension-Related Comorbidity on Health-Related Quality of Life. Asia-Pacific Journal of Public Health, 24, 753 - 763.
• Marcum, Z. A., & Gellad, W. F. (2012). Medication adherence to multi-drug regimens. Clinics in Geriatric Medicine, 28(2), 287.
• Mazzaglia, G., Ambrosioni, E., Alacqua, M., Filippi, A., Sessa, E., Immordino, V., ... & Mantovani, L. G. (2009). Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation, 120(16), 1598-1605.
• Mills, K. T., Bundy, J. D., Kelly, T. N., Reed, J. E., Kearney, P. M., Reynolds, K., ... & He, J. (2016). Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation, 134(6), 441-450.
• Moore, J. (2005). Hypertension: catching the silent killer. The Nurse Practitioner, 30(10), 16-35.
• Naqvi, A. A., Hassali, M. A., Rizvi, M., Zehra, A., Iffat, W., Haseeb, A., & Jamshed, S. (2018). Development and validation of a novel General Medication Adherence Scale (GMAS) for chronic illness patients in Pakistan. Frontiers in Pharmacology, 9, 1124.
• Ose, D., Rochon, J., Campbell, S. M., Wensing, M., Freund, T., Lieshout, J. V., ... & Ludt, S. (2014). Health-related quality of life and risk factor control: the importance of educational level in prevention of cardiovascular diseases. The European Journal of Public Health, 24(4), 679-684.
• Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England Journal of Medicine, 353(5), 487-497.
• Park, N. H., Song, M. S., Shin, S. Y., Jeong, J. H., & Lee, H. Y. (2018). The effects of medication adherence and health literacy on health‐related quality of life in older people with hypertension. International Journal of Older People Nursing, 13(3), e12196.
• Park, S. (2019). Ideal target blood pressure in hypertension. Korean Circulation Journal, 49(11), 1002.
• Peacock, E., Joyce, C., Craig, L. S., Lenane, Z., Holt, E. W., Muntner, P., & Krousel-Wood, M. (2021). Low medication adherence is associated with decline in health-related quality of life: results of a longitudinal analysis among older women and men with hypertension. Journal of Hypertension, 39(1), 153-161.
• Priatna, M., Maulida, P. S., & Alifiar, I. (2024). Utility analysis of outpatient hypertensive patients with and without comorbidities using the EQ-5D-5L instrument: A study at UPTD Puskesmas Pagerageung, Tasikmalaya Regency, West Java. Pharmacy Reports, 4(1), 81-81.
• Republic of Turkey Ministry of Health, General Directorate of Public Health, [T. C. Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü] (Mayıs 2024). 17 Mayıs hipertansiyon günü, https://hsgm.saglik.gov.tr/tr/haberler/17-mayis-ht.html. Access Date: 04/06/2025.
• Ruksakulpiwat, S., Schiltz, N., Irani, E., Josephson, R., Adams, J., & Still, C. (2024). Medication adherence of older adults with hypertension: a systematic review. Patient Preference and Adherence, 18, 957 - 975.
• Rupakheti, B., Kc, B., Bista, D., Kc, S., & Pandey, K. R. (2024). Treatment adherence and health-related quality of life among patients with hypertension at tertiary healthcare facility in Lalitpur, Nepal: A cross-sectional study. Patient Preference and Adherence, 2077-2090.
• Sabaté, E. (Ed.). (2003). Adherence to long-term therapies: evidence for action. World Health Organization.
• Shamsi, A., Nayeri, N. D., & Esmaeili, M. (2017). Living with hypertension: A qualitative research. International Journal of Community Based Nursing and Midwifery, 5(3), 219.
• Snarska, K., Chorąży, M., Szczepański, M., Wojewódzka-Żelezniakowicz, M., & Ładny, J. R. (2020). Quality of life of patients with arterial hypertension. Medicina, 56(9), 459.
• Sriyati, S., & Latif, A. (2023). Improvement medicine adherence on quality of life in hypertension patients. Media Keperawatan Indonesia. 6(2), 110.
• Stamoulis, T., Dragioti, E., Gouva, M., & Kourakos, M. (2024). The psychological profile of patients with hypertension and its role in patients’ self-care. European Psychiatry, 67(S1), S494-S495.
• Topik, M., Agil, H., & Sari, I. (2023). Relationship between duration of illness and quality of life in hypertension patients. International Journal of Nursing Information, 2(1), 1-6.
• Uchmanowicz, B., Jankowska, E., Uchmanowicz, I., & Morisky, D. (2019). Self-reported medication adherence measured with Morisky medication adherence scales and its determinants in hypertensive patients aged ≥60 years: a systematic review and meta-analysis. Frontiers in Pharmacology, 10.
• Ushakov, A.V., Ivanchenko, V.S., & Gagarina, A.A. (2016). Psychological stress in pathogenesis of essential hypertension. Current Hypertension Reviews, 12(3), 203-214.
• Vrijens, B., Vincze, G., Kristanto, P., Urquhart, J., & Burnier, M. (2008). Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. Bmj, 336(7653), 1114-1117.
• Wang, R., Zhao, Y., He, X., X., Yan, X., Sun, Y., Liu, W., Gu, Z., Zhao, J., & He, J. (2009). Impact of hypertension on health-related quality of life in a population-based study in Shanghai, China. Public Health, 123(8), 534-9.
• World Health Organization (2014). Global status report on noncommunicable diseases 2014. World Health Organization: Switzerland.
• World Health Organization (2023). Hypertension, https://www.who.int/news-room/fact-sheets/detail/hypertension. Access Date: 04/06/2025.
• Wright, J. D., Hughes, J. P., Ostchega, Y., Yoon, S. S., & Nwankwo, T. (2011). Mean systolic and diastolic blood pressure in adults aged 18 and over in the United States, 2001–2008. National Health Statistics Report, 35(1-22), 24.
• Zheng, E., Xu, J., Xu, J., Zeng, X., Tan, W., Li, J., Zhao, M., Liu, B., Liu, R., Sui, M., Zhang, Z., Li, Y., Yang, H., Yu, H., Wang, Y., Wu, Q., & Huang, W. (2021). Health-related quality of life and its influencing factors for elderly patients with hypertension: evidence from Heilongjiang province, China. Frontiers in Public Health, 9.