Factors Associated with Non-Adherence to Antihypertensive Medications Among Older Adults Attending a Tertiary Care Hospital in Lahore, Pakistan

Abstract

Background: Blood pressure pills only work if patients actually take them, yet many older adults with hypertension quietly skip doses for reasons that are rarely asked about at a routine clinic visit. Non-adherence is shaped by a mix of patient, therapy, financial, and health-system barriers, and how much each barrier matters differs from one setting to the next, which is why local evidence is needed.

Objective: To describe how well older hypertensive patients follow their medication, measure how common seven candidate barriers are, and identify which barriers are independently linked to falling short of high adherence.

Methods: A cross-sectional analytic study was conducted among 150 older adults attending a large public tertiary-care hospital. Adherence was classified as low, medium, or high, and then collapsed into a binary outcome (non-high vs. high adherence) for statistical testing. Seven barriers — forgetfulness, cost, side effects, regimen complexity, low health literacy, access difficulty, and low social support — were tested against non-high adherence using Pearson chi-square tests, followed by multivariable binary logistic regression adjusting for all seven barriers together. Independent-samples t-tests compared continuous clinical variables across adherence groups, and a chi-square test examined the link between adherence and blood-pressure control.

Results: Participants were 68.0 years old on average. Adherence was low in 22 participants (14.7%), medium in 76 (50.7%), and high in 52 (34.7%), for a combined non-high-adherence rate of 65.3%. The most common barriers were cost (48.7%), forgetfulness (46.7%), access difficulty (40.0%), and regimen complexity (38.7%). Only forgetfulness (p = .013) and side effects (p = .020) were significantly associated with non-high adherence at the bivariate level. The number of barriers a patient carried rose steadily from high adherers (2.4 ± 1.3) to low adherers (3.6 ± 1.4), F = 8.22, p < .001. In the adjusted model (χ²(7) = 18.04, p = .012; Nagelkerke R² = 0.156; 68.7% correctly classified), forgetfulness (aOR 2.71, 95% CI 1.29–5.70, p = .008) and side effects (aOR 3.27, 95% CI 1.26–8.47, p = .015) remained independent predictors; cost approached but did not reach significance (aOR 1.83, 95% CI 0.87–3.85, p = .109). Adherence category was not significantly associated with blood-pressure control (χ² = 2.71, p = .258).

Conclusion: Almost two out of three older patients fell short of high adherence, and forgetting doses and troublesome side effects stood out as the strongest, independent red flags. These findings echo the international literature on older-adult hypertension care and point toward nursing interventions that combine memory support with proactive side-effect review, rather than relying on education alone.