Yirga GK, Shiferaw K, Mekonen GS, Hiruy EG (2025) Impacts of Pills Burden on Appointment and Treatment Adherence among Hypertension Patients on Follow-Up, Mini Review. J Prev Med Healthc 7(1): 1035

Hypertension is an emerging global burden contribute in cardiovascular disease which leads morbidity and premature death [1]. It is the leading risk factor for death worldwide; with the number of attributable deaths increased from 6.8 million in 1990 to 10.8 million in 2019 and disability-adjusted life-years lost global [2]. The global prevalence of high BP is 31.1% and that the total number of persons with hypertension in 2025 will be around 1.56 billion [3]. Systematic review and meta-analysis studies showed the pooled prevalence of uncontrolled hypertension was 50.29% and 51% in sub Saharan Africa and Ethiopia respectively. Around 80% account death due to hypertension related complication in low- and middle-income countries. Poor blood pressure control and hypertension related complication related to lack of adherence to treatment [4]. Though hypertension diagnosis is simple, blood pressure control remains difficult due to non- adherence to follow-up and treatment.

Globally, only 60% of treated hypertensive patients achieve therapeutic goals. Drug non-adherence is remaining a major challenge in the management of patients with hypertension which is very difficult to prevent the complication [5]. Drug non-adherence prevalence in hypertension varies between 55.5% with self-reporting and 46.6% [6]. Missed outpatient appointment is an obstacle to the continuous of hypertensive patient care and strict medication adherence. Non-adherence is significantly related with poor clinical outcomes and increased health-care expenditure [7].

“Medicines do not work if you do not take them.” Which summarizes the issue of medication adherence—an essential element of treatment success. No-adherence to antihypertensive drugs results in uncontrolled BP, leading to cardiovascular complications [8]. Drug non-adherence is a major healthcare obstacle, especially among diseases that are mainly asymptomatic, such as hypertension [9]. Complex drug treatment schemes, poor tolerability and drug substitutions are frequent causes of poor adherence [10].

Increase pill burden was directly associated with reduced treatment adherence and persistence with antihypertensive therapies in real-practice settings [11]. Pill burden is associated with poor appointment adherence and medication adherence, the higher the medications burden the lower the level of medication adherence [12]. The hypertensive patients with pill burdens were non-compliance to their appointment follow-up in the hypertensive follow-up. Likewise, Single-pill combination therapy leads to improved treatment compared with free equivalent combination therapy [13]. Non-compliance to medication decreased by 26% when people took fixed dose combinations for conditions such as hypertension [14]. A cohort study revealed that there were more non adherent patients in the multiple-pill cohort than in the single-pill cohort. An increased number of prescribed antihypertensive drugs are related to the higher rate of non-adherence to treatment [15].

The possible cause for this poor adherence follows up and noncompliance for anti-hypertension medication may be drug side effect, drug- drug interactions and health expenditure. Studies evidenced that Antihypertensive drug-related symptoms and side effects are frequently cited as a main cause of non-adherence [16]. It is estimated that about 20–97% of patients who take antihypertensive medications experience drug side effects [17]. Mostly the management of hypertension is lifelong, which carries the risk of adverse drug reactions [18]. Poly-pharmacy may increase the burden of disease and therapy and increase the difficulty of understanding the purpose of each prescribed medication which also contribute to increased expenditure [19]. In addition to Poly-pharmacy, which refers to the simultaneous usage of multiple medications, has been found to be a risk factor for drug –drug interaction [20].

All Authors’ contribute completed the article reviewed read and signed the final draft.

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