Adherence to anti-hypertensive agents and their associated factors among haemodialysis patients in Hospital Raja Perempuan Zainab II, Kelantan, Malaysia: a cross-sectional study

Suzana Mustafa, Siti Addawiyah Mohd Dzulkiflee, Nur Husna Ibrahim, Siew Hua Gan, Suk Peng Tang


The study aims to determine the adherence to anti-hypertensive agents as well as the factors influencing adherence levels among patients undergoing haemodialysis in Hospital Raja Perempuan Zainab II (HRPZ II), Kelantan, Malaysia. A total of 82 patients were enrolled in this study. A convenience sampling was done based on the number of haemodialysis patients registered in the study centre (Haemodialysis Unit, HRPZ II, Kelantan, Malaysia) who were also on anti-hypertensives. A validated Medication Compliance Questionnaire which consisted of ten questions gauging drug-taking and drug-stopping behaviours among Malaysian hypertensive patients was used to measure adherence. The majority (84.1%) of patients adhere to their anti-hypertensives. Despite this fact, only 42.7% of the patients achieved the target blood pressure (BP) control. A multiple logistic regressions analysis showed that uncontrolled diastolic BP [adjusted odds ratio (OR) = 0.928 (95% CI: 0.873 – 0.987); p = 0.018] and cigarette smoking [adjusted OR = 11.62 (95% CI: 1.55 – 86.99); p = 0.017] were independent factors for non-adherence to anti-hypertensives in this study indicating that patient’s education and support may be necessary. Although a good adherence to anti-hypertensives were observed among haemodialysis patients, BP control remains poor due to poor control of diastolic BP and cigarette smoking. 


Adherence, anti-hypertensives, haemodialysis

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Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2019. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2019.

Agarwal R, Nissenson AR, Batlle D, Coyne DW, Trout JR, Warnock DG. Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. The American Journal of Medicine. 2003;115(4):291-7.

DOPPS. Annual Report of the Dialysis Outcomes and Practice Patterns Study: Hemodialysis Data 1997-2011. Arbor Research Collaborative for Health, Ann Arbor, MI; 2012.

National Renal Registry. 26th Report of the Malaysian Dialysis and Transplant Registry 2018. Kuala Lumpur.

Wong HS, Goh BL. Twenty forth Report of the Malaysian Dialysis and Transplant 2016. Kuala Lumpur; 2018.

Schmitt KE, Edie CF, Laflam P, Simbartl LA, Thakar CV. Adherence to antihypertensive agents and blood pressure control in chronic kidney disease. American Journal of Nephrology. 2010;32(6):541-8.

Burnier M, Pruijm M, Wuerzner G, Santschi V. Drug adherence in chronic kidney diseases and dialysis. Nephrology Dialysis Transplantation. 2015;30(1):39-44.

Aziz AM, Ibrahim MI. Medication noncompliance--a thriving problem. The Medical Journal of Malaysia. 1999;54(2):192-9.

Ramli A, Ahmad NS, Paraidathathu T. Medication adherence among hypertensive patients of primary health clinics in Malaysia. Patient Preference and Adherence. 2012;6:613-622.

Hassan NB, Hasanah CI, Foong K, Naing L, Awang R, et al. Identification of psychosocial factors of noncompliance in hypertensive patients. Journal of Human Hypertension. 2006;20(1):23-9.

Svarstad BL, Chewning BA, Sleath BL, Claesson C. The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Education and Counseling. 1999;37(2):113–24.

Duong M, Piroth L, Grappin M, Forte F, Peytavin G, et al. Evaluation of the Patient Medication Adherence Questionnaire as a tool for self-reported adherence assessment in HIV-infected patients on antiretroviral regimens. HIV Clinical Trials. 2001;2(2):128–35.

Schmieder RE, Ott C, Schmid A, Friedrich S, Kistner I, et al. Adherence to antihypertensive medication in treatment-resistant hypertension undergoing renal denervation. Journal of the American Heart Association. 2016;5(2):e002343.

Ministry of Health Malaysia. Clinical Practice Guidelines: Management of Hypertension, 5th Edition. 2018.

Ghimire S, Castelino RL, Lioufas NM, Peterson GM, Zaidi STR. Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review. PLOS ONE. 2015;10(12):e0144119.

Gosmanova EO, Kovesdy CP. Adherence to antihypertensive medications: is prescribing the right pill enough? Nephrology Dialysis Transplantation. 2015;30(10):1649-56.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-52.

Lloyd-Jones DM, Evans JC, Larson MG, O'Donnell CJ, Roccella EJ, Levy D. Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in the community. Hypertension. 2000;36(4):594-9.

Witt DR, Garrison GM, Gonzalez CA, Witt TJ, Angstman KB. Six-Month Outcomes for Collaborative Care Management of Depression Among Smoking and Nonsmoking Patients. Health Services Research and Managerial Epidemiology. 2017;4:2333392817721648.

Sherman BW, Lynch WD. The association of smoking with medical treatment adherence in the workforce of a large employer. Patient preference and adherence. 2014;8:477-86.

Aggarwal B, Mosca L. Lifestyle and Psychosocial Risk Factors Predict Non-adherence to Medication. Annals of behavioral medicine: a publication of the Society of Behavioral Medicine. 2010;40(2):228-33.

Burnier M, Polychronopoulou E, Wuerzner G. Hypertension and Drug Adherence in the Elderly. Frontiers in Cardiovascular Medicine. 2020;7:49.

Ferrari CMM, de Sousa RMC, Castro LHM. Factors associated with treatment non-adherence in patients with epilepsy in Brazil. Seizure. 2013;22(5):384-9.

Chandra IS, Kumar KL, Reddy MP, Reddy CMPK. Attitudes

toward Medication and Reasons for Non-Compliance in Patients with Schizophrenia. Indian Journal of Psychological Medicine. 2014;36(3):294-8.

Chan YM, Zalilah MS, Hii SZ. Determinants of Compliance Behaviours among Patients Undergoing Hemodialysis in Malaysia. PLoS ONE. 2012;7(8):e41362.

Ghimire S, Castelino RL, Jose MD, Zaidi STR. Medication adherence perspectives in haemodialysis patients: a qualitative study. BMC Nephrology. 2017;18(1):167.

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