MEDICATION ADHERENCE AND ITS DETERMINANTS AMONG PATIENTS WITH HYPERTENSION AND TYPE 2 DIABETES MELLITUS: A MULTICENTER CROSS-SECTIONAL STUDY

Abstract

Background: Hypertension and type 2 diabetes mellitus (T2DM) frequently coexist and substantially increase the risk of cardiovascular disease, renal complications, and premature mortality. Medication adherence is a key modifiable determinant of treatment success, yet multicenter evidence from Khyber Pakhtunkhwa, Pakistan, remains limited.

Objective: To determine the prevalence of medication adherence and identify socio-demographic, clinical, and health-system factors associated with adherence among adults with hypertension, T2DM, or both attending tertiary care outpatient departments (OPDs) in Peshawar.

Methods: A multicenter cross-sectional study was conducted over six months in tertiary care OPDs in Peshawar. Adults with confirmed hypertension, T2DM, or both were recruited using consecutive sampling. Medication adherence was assessed using the licensed 8-item Morisky Medication Adherence Scale (MMAS-8). Socio-demographic, clinical, and treatment-related data were collected using a structured interviewer-administered questionnaire. Multivariable logistic regression identified independent predictors of low adherence, reported as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

Results: Of 520 eligible patients, 476 participated (response rate: 91.5%). The mean age was 54.8 ± 9.2 years, and 53.4% were female. High, medium, and low adherence were observed in 24.4%, 36.1%, and 39.5% of participants, respectively. Low adherence was significantly more common among patients with both hypertension and T2DM (51.5%) than those with either condition alone (p < 0.001). Independent predictors of low adherence included polypharmacy (AOR = 2.34), low household income (AOR = 1.86), inadequate physician counseling (AOR = 2.11), and lack of formal education (AOR = 1.54).

Conclusion: Medication nonadherence was common among patients with hypertension and T2DM. Reducing pill burden, strengthening physician counseling, improving affordability, and addressing health literacy may enhance adherence and improve long-term outcomes.