Understanding why rural hypertensive patients fail to stick with their treatment

A new study by icddr,b scientists examines the reasons behind non-adherence to hypertension treatment, which leaves patients vulnerable to risk of stroke and related heart disease. 
Bangladesh faces a high and growing prevalence of non-communicable diseases (NCDs). Hypertension (high blood pressure) in particular poses a serious threat to public health.  Almost a third of women and 20% of men older than 35 years of age in Bangladesh have high blood pressure. Globally more than 60% of all deaths are said to be due to NCDs, amounting to 35 million people each year.  Low- and middle-income countries (LMICs) bear 80% of this mortality burden. High blood pressure is the greatest risk factor for strokes and heart disease.  
Photo by Jasleen Kaur / CC BY-SA 2.0
Previous studies have shown that treatment can greatly reduce the effects of hypertension, such as strokes, by over 40%. Compliance with medication regimes and long-term adherence to treatment are essential for controlling hypertension. However, in developing countries adherence to medication in general tends to be lower than other parts of the world due to patients’ lack of access and scarcity of healthcare resources.
A new icddr,b study, published in Global Health Action and led by icddr,b scientist Dr Masuma Akter Khanam and colleagues, makes one of the first attempts in Bangladesh to examine the reasons behind poor adherence to hypertension treatment. They found that men, young people, patients with low levels of education and those treated by village doctors are more at risk of non-adherence; that is, unlikely to complete their course of medication.
Using data from three rural demographic surveillance sites, Dr Khanam and colleagues found that 13.7% of the study population was hypertensive, over 26% of whom failed to continue treatment. More men (29.2%) discontinued the treatment than women (24.3%), and the risk of non-adherence decreased with age, with young people more likely to discontinue treatment. Poorer and less educated patients are also more at risk of non-adherence.
This study also highlights the importance of the quality of health care providers in patient adherence to treatment. They found that patients diagnosed by village doctors and other unqualified or under-qualified practitioners (such as community health workers, nurses, paramedics, homeopaths, spiritual healers and pharmacists) were more likely to discontinue treatment. This is particularly problematical, since village doctors and other unqualified health workers diagnosed almost half of all patients with hypertension.
Dr Khanam and colleagues stress the need for more research to understand how these various factors contribute to treatment non-adherence. In particular, they point out that village doctors and informal healthcare workers play a large and important role in providing health services not only in Bangladesh but also in many low-income countries. Therefore, understanding their hypertension management practices is crucial. They also call for more research to understand the determinants of adherence to treatment among various demographic groups, particularly men and young people.
The study was funded by a grant from the United Health Group, along with support from the National Institutes of Health Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Eye Institute, National Heart, Blood, and Lung Institute, National Institute of Dental & Craniofacial Research, National Institute On Drug Abuse, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases Health, and NIH Office of Women’s Health and Research through the International Clinical Research Fellows Program at Vanderbilt University and the American Relief and Recovery Act.