Introduction: Hypertension control depends strongly on treatment adherence, yet adherence remains suboptimal in many low- and middle-income countries. Addressing suboptimal hypertension treatment adherence is a public health priority in developing countries like Vietnam. This study aimed to determine the level of treatment adherence and identify factors associated with nonadherence to hypertension treatment among patients in Can Tho City, Vietnam. Methods: A cross-sectional study was conducted among 434 hypertensive patients managed at commune health stations in Can Tho City, Vietnam, in 2022. Treatment adherence was assessed across six domains, including medication adherence (MMAS-8), diet, smoking cessation, alcohol restraint, physical activity, and follow-up monitoring. Multivariable logistic regression was used to identify factors associated with non-adherence. Results: Overall treatment adherence was 45.6%. Medication adherence was 59.0%, whereas adherence to follow-up monitoring was 48.8%. Female patients demonstrated significantly higher overall treatment adherence than males (55.5% vs. 30.4%, p < 0.001). In multivariable analyses, male sex, lack of health insurance, poor patient-doctor relationship, and not actively seeking hypertensionrelated information were independently associated with non-adherence. Sex-stratified analyses further identified differences in factors associated with non-adherence between men and women. In addition, patients with treatment adherence had significantly lower systolic and diastolic blood pressure than non-adherent patients. Discussion: Treatment adherence among hypertensive patients remained suboptimal. Poor patientdoctor relationship was consistently associated with non-adherence, while factors associated with non-adherence differed between men and women. Better treatment adherence was also associated with lower blood pressure. Conclusion: Treatment adherence among hypertensive patients in Can Tho City remained suboptimal. Interventions focusing on strengthening patient-doctor relationships, improving patient education and engagement, and reducing financial barriers may improve long-term treatment adherence and hypertension management.
Background: Therapeutic inertia has been identified as a major factor in poor blood pressure control. This study aimed to investigate factors associated with therapeutic inertia in hypertension management among Moroccan General Practitioners (GPs). Methods: A descriptive and analytical cross-sectional study was conducted from October 2021 to January 2022, involving Moroccan general practitioners using an anonymous questionnaire developed specifically for this study, covering numerous areas: their socio-demographic characteristics, assessment of hypertension knowledge, reasons not to intensify therapy, and clinical scenarios. A univariate analysis was performed using the Chi-square test to compare percentages. A multivariable logistic regression analysis was also applied to study variables possibly associated with therapeutic inertia. Results: A total of 130 physicians participated in this study. Most of the practitioners were female (62.3%). The median age was 32 years (IQR, 26–50). The percentage of physicians who had practiced for 5 years or less was 51.5%, compared with 48.5% who had practiced for more than 5 years. The median number of patients seen per day was estimated at 30 patients with an interquartile range of [15, 50]. The median consultation duration was 10 minutes (IQR, 5–15). Using the study-defined cutoff of ≥2, 78.5% of physicians met the criterion for therapeutic inertia (95% CI, 70.4%–85.2%). Furthermore, the two main reasons for therapeutic abstention reported by physicians were: the importance of improving patient compliance, lifestyle, and dietary measures before intensifying treatment (81.5%), in addition to the perception that office blood pressure does not reflect the patient's "true" blood pressure (BP) and therefore does not support immediate treatment intensification without further ambulatory monitoring (43.8%). Discussion: This study found a high prevalence of therapeutic inertia in primary care. The study’s results found that the advanced age of the hypertensive patient was inversely related to clinical inertia. Multivariable regression showed that when the patient is diabetic, the general practitioners tend to be 4 times more ‘therapeutically inert’ [OR 4.42 (95% CI 1.2–7.23)]. A patient’s history of ischemic stroke was also positively associated with Therapeutic Inertia (TI) [OR 1.53 (95% CI 1.23–4.23)]. Conclusion: Therapeutic inertia was common among participating Moroccan general practitioners and varied across clinical contexts. According to our study, the history of diabetes or stroke was positively associated with inertia. Given the exploratory nature of the study and its sampling limitations, these findings require confirmation in larger and more representative studies.
Introduction:: The effectiveness of controlling blood pressure when prescribing a fixed combination (“polypill”) compared to monocomponent drugs has not been fully determined. According to the studies conducted, some demonstrate statistically significant differences in mean blood pressure levels when taking a “polypill” compared to monocomponent drugs, while others do not reveal this effect. The aim was to evaluate the efficacy of “polypill” in lowering blood pressure in patients with Cardiovascular (CV) diseases compared to monocomponent drugs. Methods:: The search was conducted according to PRISMA guidelines in PubMed, Google Scholar, and ClinicalTrials databases. Finally, 10 studies were selected. The dynamics of the mean systolic and diastolic pressure in patients taking “polypill” was evaluated in comparison to monocomponent drugs. Results:: During the identification stage, 568 publications were found. At the screening phase, 321 papers, such as books, reviews, systematic reviews, meta-analyses, etc were excluded. 168 papers were assessed for eligibility. After the eligibility assessment, 158 papers were excluded for deviations from the study design (e.g., no control group, no direct comparison between “polypill” and monocomponent drug therapy, data presented as median and interquartile range, placebo as the control group, etc.). In the final analysis, we included 10 publications that evaluated the effect of a fixed combination of medications (“polypill”) compared with monocomponent therapy on blood pressure. During further sub-analyses, 1 study was excluded. The meta-analysis of the clinical efficacy of “polypill” control of blood pressure was conducted in comparison with standard therapy and comprised 9 studies, involving patients with previous myocardial infarction, acute cerebrovascular accident, high CV risk, hypertension and dyslipidemia. In total, all of the studies enrolled 6264 people, of whom 3147 patients received “polypill”, and 3117 patients – monocomponent drugs. The meta-analysis demonstrated that fixed-dose combination therapy yielded a statistically significant difference compared to standard therapy with respect to its impact on systolic (standardized mean difference: -0.128; (-0.177; -0.08); p < 0.01) and diastolic (standardized mean difference: -0.171; (-0.233; -0.11); p < 0.01) blood pressure. Discussion:: The findings of the conducted meta-analysis support the evidence of beneficial switching to “polypill” therapy in patients with hypertension, especially in cases requiring a multi-drug regimen. Conclusion:: “Polypill” therapy in patients with CV diseases, hypertension, dyslipidemia, and high CV risk is associated with more effective blood pressure control compared to monocomponent drugs.
