Impact of Non-compliance with Antihypertensive Management on Development of Stroke among Hypertensive Patients: A Case–Control Study

Abstract

Introduction: Hypertension and stroke are two major health problems in India. Uncontrolled hypertension increases the chances of development of stroke. The main reason for inadequate control of blood pressure is non-compliance to the treatment regimen; both pharmacological and behavioral. The aim and objective of the study were to assess the relationship between non-compliance to antihypertensive management and development of stroke. It was also aimed to identify non-compliance among patients with hypertension.

Materials and Methods: This was a one to two individually matched case–control study conducted among 139 cases and 278 controls in a tertiary care hospital of West Bengal. A self-developed validated questionnaire was used to obtain information regarding compliance from hypertensive people and patients with stroke. Antihypertensive management regimen included compliance to medication, dietary restrictions, exercise, cessation of smoking, and cessation or restriction of alcohol intake. Medication adherence was assessed using four-item questionnaires on a five-point Likert scale. A score >9 was considered as non-compliant. Other components were assessed with “Yes” or “No” questions. Atotal score of four out of five were considered as compliant to antihypertensive management. Descriptive statistics such as mean, percentage, and inferential statistics such as Mantel-Haenszel odds ratio (ORMH) were used in this study.

Results: The mean age of cases was 51.62 (±5.1 standard deviation [SD]) and that of controls was 54.79 (±4.1 SD). Sample characteristics were equally distributed among cases and controls except for educational qualification and income. Nearly half (46%) of the sample were in the age group of 56–60 years of age. The exposure to non-compliance increases the odds of getting a stroke and was highly significant (P < 0.05).

Conclusion: There is a significant association between non-compliance to antihypertensive management and development of stroke. It is important to conduct an awareness program among hypertensive people regarding the importance of compliance to the treatment regimen. More consideration and care should be given to enhance the behavioral aspects of the management of hypertension to improve compliance