Medication adherence in patients with hypertension: a Systematic Review
Abstract
Introduction: Medication adherence plays a critical role in the effective management of hypertension. Despite the availability of effective antihypertensive therapies, suboptimal adherence remains a major barrier to blood pressure control worldwide.
Objective: Understanding the factors associated with medication adherence is essential to inform clinical practice and nursing interventions in chronic disease management.
Material and method: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive literature search was performed in PubMed, ScienceDirect, Wiley Online Library, and ProQuest for studies published in English between January 2000 and December 2024. Observational studies examining factors associated with antihypertensive medication adherence among adult patients with hypertension were included. A narrative thematic synthesis was used to integrate the findings.
Results: The initial search yielded 1,658 records, of which 29 studies met the inclusion criteria. Factors influencing medication adherence were grouped into four analytical categories: individual internal factors, healthcare facility–related factors, medication-related factors, and clinical factors. Individual internal factors were most frequently reported; however, adherence behavior reflected complex interactions across all categories.
Conclusions: Medication adherence among patients with hypertension is influenced by multiple interacting determinants rather than a single dominant factor. Strengthening nursing-led education, counseling, and follow-up strategies may help address modifiable barriers to adherence and support long-term hypertension management across diverse healthcare settings.
Downloads
-
Abstract7
-
ESP_PDF (Español (España))6
-
ENG_PDF0
-
XML0
References
1. Sudayasa IP, Husdaningsih F, Alifariki LO. Polymorphism of Gene ACE I/D and Family History of Hypertension as Predisposition of Hypertension. Malaysian Journal of Medicine & Health Sciences. 2023;19(3). DOI: https://doi.org/10.47836/mjmhs19.3.22
2. Religioni U, Barrios-Rodríguez R, Requena P, Borowska M, Ostrowski J. Enhancing therapy adherence: impact on clinical outcomes, healthcare costs, and patient quality of life. Medicina (B Aires). 2025;61(1):153. DOI:10.3390/medicina6100153
3. Uchmanowicz B, Chudiak A, Uchmanowicz I, Rosińczuk J, Froelicher ES. Factors influencing adherence to treatment in older adults with hypertension. Clin Interv Aging. 2018; 13:2425–41. DOI: 10.2147/CIA.S182881
4. Bekker CL, Aslani P, Chen TF. The use of medication adherence guidelines in medication taking behaviour research. Research in Social and Administrative Pharmacy [Internet]. 2022;18(2):2325–30. DOI: 10.1016/j.sapharm.2021.10.012
5. Choudhry NK, Kronish IM, Vongpatanasin W, Ferdinand KC, Pavlik VN, Egan BM, et al. Medication Adherence and Blood Pressure Control: A Scientific Statement from the American Heart Association. Hypertension [Internet]. 2022 Jan 1;79(1): e1–14. Available from: https://doi.org/10.1161/HYP.0000000000000203
6. Burnier M, Egan BM. Adherence in Hypertension. Circ Res [Internet]. 2019 Mar 29;124(7):1124–40. Available from: https://doi.org/10.1161/CIRCRESAHA.118.313220
7. Kvarnström K, Westerholm A, Airaksinen M, Liira H. Factors contributing to medication adherence in patients with a chronic condition: A scoping review of qualitative research. Vol. 13, Pharmaceutics. MDPI AG; 2021. DOI: 10.3390/pharmaceutics13040450
8. Carey RM, Wright JT, Taler SJ, Whelton PK. Guideline-Driven Management of Hypertension. Circ Res [Internet]. 2021 Apr 2;128(7):827–46. Available from: https://doi.org/10.1161/CIRCRESAHA.121.318083
9. Berardinelli D, Conti A, Hasnaoui A, Casabona E, Martin B, Campagna S, et al. Nurse-Led Interventions for Improving Medication Adherence in Chronic Diseases: A Systematic Review. Vol. 12, Healthcare (Switzerland). Multidisciplinary Digital Publishing Institute (MDPI); 2024. DOI: 10.3390/healthcare12040471
10. Ruswati R. The Role of Nurses in Enhancing Medication Adherence and Patient Outcomes in Hypertension Management. International Journal of Nursing and Midwifery Research. 2024 Jul;2(3):78–87. DOI: https://doi.org/10.35335/ners.v2i3.286
11. Abbas H, Kurdi M, de Vries F, van Onzenoort HAW, Driessen JHM, Watfa M, et al. Factors Associated with Antihypertensive Medication Non-Adherence: A Cross-Sectional Study Among Lebanese Hypertensive Adults. Patient Prefer Adherence [Internet]. 2020 Apr 1;14(null):663–73. DOI: 10.2147/PPA.S238751
12. Chen Y, Gao J, Lu M. Medication adherence trajectory of patients with chronic diseases and its influencing factors: A systematic review. J Adv Nurs. 2023 Jan 5;80(1):11–41. DOI: 10.1111/jan.15740
13. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International Journal of Surgery. 2021; 88:105906. DOI: 10.1016/j.ijsu.2021.105906
14. Abel WM, Efird JT. The association between trust in health care providers and medication adherence among Black women with hypertension. Front Public Health. 2013;(DEC). DOI: 10.3389/fpubh.2013.00078
15. Baggarly SA, Kemp RJ, Wang X, Magoun AD. Factors associated with medication adherence and persistence of treatment for hypertension in a Medicaid population. Research in Social and Administrative Pharmacy. 2014;10(6): e99-112. DOI: 10.1016/j.sapharm.2014.02.005
16. Kressin NR, Wang F, Long J, Bokhour BG, Orner MB, Rothendler J, et al. Hypertensive patients’ race, health beliefs, process of care, and medication adherence. J Gen Intern Med. 2007;22(6):768–74. DOI: 10.1007/s11606-007-0175-3
17. Lor M, Koleck TA, Bakken S, Yoon S, Dunn Navarra AM. Association between health literacy and medication adherence among hispanics with hypertension. J Racial Ethn Health Disparities. 2019; 6:517–24. DOI: 10.1007/s40615-018-0481-6
18. Patel RP, Taylor SD. Factors Affecting Medication Adherence in Hypertensive Patients. Ann Pharmacother. 2002; 36:40–4. DOI: 10.1345/aph.1A066
19. Rajpura J. Medication Adherence in a Sample of Elderly Suffering from Hypertension: Evaluating the Influence of Illness Perceptions, Treatment Beliefs, and Illness Burden. Journal of Managed Care Pharmacy. 2014;20(1):58–65. DOI: 10.18553/jmcp.2014.20.1.58
20. Roumie CL, Greevy R, Wallston KA, Elasy TA, Kaltenbach L, Kotter K, et al. Patient centered primary care is associated with patient hypertension medication adherence. J Behav Med. 2011;34(4):244–53. DOI: 10.1007/s10865-010-9306-1
21. Lo SHS, Chau JPC, Woo J, Thompson DR, Choi KC. Adherence to antihypertensive medication in older adults with hypertension. Journal of Cardiovascular Nursing. 2016;31(4):296–303. DOI: 10.1097/JCN.0000000000000264
22. Li WTL, Kang CD, Tsang PPM, Wang HHX, Liu KQL, Chan WM, et al. Determinants of medication adherence and blood pressure control among hypertensive patients in Hong Kong: A cross-sectional study. Int J Cardiol. 2015; 182:250–7. DOI: 10.1016/j.ijcard.2015.01.049
23. Ma C. A cross-sectional survey of medication adherence and associated factors for rural patients with hypertension. Applied Nursing Research. 2016; 31:94–9. DOI: 10.1016/j.apnr.2016.01.004
24. Shi S, Shen Z, Duan Y, Ding S, Zhong Z. Association between medication literacy and medication adherence among patients with hypertension. Front Pharmacol. 2019; 10:822. DOI: 10.3389/fphar.2019.00822
25. Wang W, Lau Y, Loo A, Chow A, Thompson DR. Medication adherence and its associated factors among Chinese community-dwelling older adults with hypertension. Heart and Lung: Journal of Acute and Critical Care. 2014;43(4):278–83. DOI: 10.1016/j.hrtlng.2014.03.004
26. Bhusal A, Jadhav P, Deshmukh Y. Assessment of medication adherence among hypertensive patients: a cross-sectional study. Int J Basic Clin Pharmacol. 2016;1606–12. DOI: https://doi.org/10.18203/2319-2003.ijbcp20162480
27. Thomas D, Meera NK, Binny K, Sekhar MS, Kishore G, Sasidharan S. Medication adherence and associated barriers in hypertension management in India. CVD Prev Control. 2011 Jan;6(1):9–13. DOI: 10.1016/j.cvdpc.2011.01.002
28. Rahmawati R, Bajorek B. Factors affecting self-reported medication adherence and hypertension knowledge: A cross-sectional study in rural villages, Yogyakarta Province, Indonesia. Chronic Illn. 2018;14(3):212–27. DOI: 10.1177/1742395317710313
29. Alfian SD, Annisa N, Perwitasari DA, Coelho A, Abdulah R. The role of illness perceptions on medication nonadherence among patients with hypertension: A multicenter study in indonesia. Front Pharmacol. 2022;13. DOI: 10.3389/fphar.2022.870429
30. Kamran A, Ahari SS, Biria M, Malepour A, Heydari H. Determinants of Patient’s Adherence to Hypertension Medications: Application of Health Belief Model Among Rural Patients. Ann Med Health Sci Res. 2015;4(6):922–7. DOI: 10.4103/2141-9248.149779
31. Mahmoudian A, Zamani A, Tavakoli N, Farajzadegan Z, Fathollahi-Dehkordi F. Medication adherence in patients with hypertension: Does satisfaction with doctor-patient relationship work? Journal of Research in Medical Sciences. 2017;22. DOI: 10.4103/1735-1995.200277
32. Jankowska-Polańska B, Uchmanowicz I, Dudek K, Mazur G. Relationship between patients’ knowledge and medication adherence among patients with hypertension. Patient Prefer Adherence. 2016; 10:2437–47. DOI: 10.2147/PPA.S119994
33. Karakurt P, Kaşikçi M. Factors affecting medication adherence in patients with hypertension. Journal of Vascular Nursing. 2012;30(4):118–26. DOI: 10.1016/j.jvn.2012.06.001
34. Boratas S, Kilic HF. Evaluation of medication adherence in hypertensive patients and influential factors. Pak J Med Sci. 2018;34(4):959–63. DOI: 10.12669/pjms.344.14924
35. Durand H, Hayes P, Harhen B, Conneely A, Finn DP, Casey M, et al. Medication adherence for resistant hypertension: Assessing theoretical predictors of adherence using direct and indirect adherence measures. Br J Health Psychol. 2018;23(4):949–66. DOI: 10.1111/bjhp.12326
36. Ramli A, Ahmad NS, Paraidathathu T. Medication adherence among hypertensive patients of primary health clinics in Malaysia. Patient Prefer Adherence. 2012; 6:613–22. DOI: 10.2147/PPA.S34750
37. Nakwafila O, Mashamba-Thompson T, Godi A, Sartorius B. A Cross-Sectional Study on Hypertension Medication Adherence in a High-Burden Region in Namibia: Exploring Hypertension Interventions and Validation of the Namibia Hill-Bone Compliance Scale. Int J Environ Res Public Health. 2022;19(7). DOI: 10.3390/ijerph19074233
38. Al-Noumani H, Wu JR, Barksdale D, Knafl G, Alkhasawneh E, Sherwood G. Health beliefs and medication adherence in omanis with hypertension. Journal of Cardiovascular Nursing. 2018;33(6):518–26. DOI: 10.1097/JCN.0000000000000492
39. Park YH, Kim H, Jang SN, Koh CK. Predictors of adherence to medication in older Korean patients with hypertension. European Journal of Cardiovascular Nursing. 2013;12(1):17–24. DOI: 10.1177/1474515112438452
40. Khan MU, Shah S, Hameed T. Barriers to and determinants of medication adherence among hypertensive patients attended National Health Service Hospital, Sunderland. J Pharm Bioallied Sci. 2014;6(2):104–8. DOI: 10.4103/0975-7406.129170
41. Thuy LT, Monkong S, Pookboonmee R, Leelacharas S, Viwatwongkasem C. Factors Explaining Medication Adherence of Older Adults with Hypertension: A Cross-sectional Study. Pac Rim Int J Nurs Res Thail. 2020;24(3): https://he02.tci-thaijo.org/index.php/PRIJNR/artic
42. Thomas D, Meera NK, Binny K, Sekhar MS, Kishore G, Sasidharan S. Medication adherence and associated barriers in hypertension management in India. CVD Prev Control. 2011;6(1):9–13. DOI: 10.1016/j.cvdpc.2010.11.001
43. Kardas P, Almada M, Malo S, Midão L, Vrijens B, Aguilar-Palacio I, et al. The need for patient adherence standard measures for Big Data. 2020; DOI: 10.2196/18150
44. García-Ovejero E, Pisano-González M, Salcedo-Diego I, Serrano-Gallardo P. Impact of Chronic Disease Self-Management Program on the Self-Perceived Health of People in Areas of Social Vulnerability in Asturias, Spain. Healthcare (Switzerland). 2024 Apr 1;12(8). DOI: 10.3390/healthcare12080918
45. Karakurt, Papatya; Bilgin, Sonay; Özdemir, Selen. Association between health literacy and medication adherence in patients with hypertension: a cross-sectional study. Scientific Reports, 2025. DOI: https://doi.org/10.1038/s41598-025-30399-2
46. Guo, Aizhen, et al. Impact of health literacy and social support on medication adherence in patients with hypertension: a cross-sectional community-based study. BMC Cardiovascular Disorders, 2023, 23.1: 93. DOI: 10.1186/s12872-023-03193-0
47. Kim, Dayea; Cha, Jaewoo. Association between medical complications according to continuity of care and medication adherence in patients with hypertension in Korea: a national population-based cohort study. BMJ open, 2023, 13.6: e073404. DOI: 10.1136/bmjopen-2023-073404
48. Ljungholm L, Klinga C, Edin-Liljegren A, Ekstedt M. What matters in care continuity on the chronic care trajectory for patients and family carers?. A conceptual model. J Clin Nurs. 2022 May 1;31(9–10):1327–38. DOI: 10.1111/jocn.16074
49. Spencer J, Bahuguna M, Ramani S, Pathak S, Shende S, Pantvaidya S, et al. What constitutes ‘poor’ adherence to medical advice for chronic diseases? Insights from a qualitative study among hypertension and diabetes patients in urban informal settlements, Mumbai Metropolitan Region. PLoS One [Internet]. 2025 Nov 18;20(11): e0324765-. Available from: https://doi.org/10.1371/journal.pone.0324765
50. Burnier M. The role of adherence in patients with chronic diseases. Eur J Intern Med [Internet]. 2024; 119:1–5. DOI: 10.1016/j.ejim.2023.10.012
51. Adeyemi AH, Wiredu B, Okobi OE, Nebuwa P, Ezeani EI, Alozie AS. Challenges and Strategies in Medication Management for Patients with Multiple Comorbidities. Cureus. 2025 jun 14; DOI: 10.7759/cureus.85992
52. Yazie TS, Mengistu WE, Yimer YS, Dagnew SB, Dagnew FN, Moges TA, et al. Clinical factors associated with multimorbidity, polypharmacy and medication regimen complexity among adults with hypertension: a multicentre cross-sectional study. BMJ Open [Internet]. 2025 Apr 1;15(4): e091997. DOI: 10.1136/bmjopen-2024-091997
Copyright (c) 2026 Global Nursing
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The works published in this magazine are subject to the following terms:
1. The Publications Service of the University of Murcia (the publisher) preserves the copyright of the published works, and encourages and allows the reuse of the works under the license for use stated in point 2.
© Servicio de Publicaciones, Universidad de Murcia, 2011 (© Publications Service, University of Murcia, 2011)
2. The works are published in the electronic edition of the journal under Creative Commons Reconocimiento-NoComercial-SinObraDerivada 3.0 España(texto legal) “ a Attribution-NonCommercial-NoDerivatives 3.0 Spain license (legal text)”. They can be copied, used, broadcasted, transmitted and publicly displayed, provided that: i) the authorship and original source of their publication (journal, publisher and URL) are cited; (ii) are not used for commercial purposes; iii) the existence and specifications of this license is mentioned.
3. Conditions of self-archiving. Authors are allowed and encouraged to electronically disseminate the pre-print (pre-reviewed ) and / or post-print (reviewed and accepted for publication) versions of their works prior to publication, as it ensures a wider circulation and dissemination which may lead to a possible increase in its mention and a higher scope among the academic community. RoMEO color: green.
