Barriers to Compliance of Hypertensive Patients in Abha City, Saudi Arabia

Aim of Study: To measure non-compliance and to identify barriers to compliance among hypertensive patients. Patients and Methods: A total of 200 hypertensive patients attending Al-Qabel Primary Health Care (PHC) Center since at least one year were included in this study. A structured data collection interview questionnaire was used. To assess non-compliance of hypertensive patients, the Hill-Bone Non-Compliance to High Blood Pressure Therapy Scale was used. Results: Only 11% of hypertensive patients were highly compliant. The main barriers for full compliance were forgetfulness (39%) and being asymptomatic (30%). Some patients were non-compliant as a result of disliking the manner of medical service provided by the primary health care (PHC) team (16%), or they felt the need to take some rest from the daily antihypertensive medication (15.5%). Controlled blood pressure was achieved among 58% of patients. Saudis were significantly more non-compliant than non-Saudis (p<0.001). Married patients expressed significantly higher non-compliance than single patients (p=0.015). Non-compliance scores were significantly higher among smokers than nonsmokers (p<0.001); and significantly higher among patients who were treated with multiple antihypertensive drugs (p=0.019). Patients with uncontrolled systolic or diastolic blood pressure had significantly higher non-compliance mean scores (p<0.001 for both). Conclusions: Non-compliance of hypertensive patients attending PHC settings in Abha is high. Main barriers against full compliance of hypertensive patients are forgetfulness, absence of symptoms, dissatisfaction with provided health care and being tired of treatment side effects. Non-compliance is significantly higher among younger, newly diagnosed, Saudi, married and smoker patients. Non-compliance is also significantly higher among hypertensive patients on multiple antihypertensive medications. Recommendations: Health education of hypertensive patients should cover information on the disease, medication, exercise, diet and follow up visits. Patients should be advised to include self-reminders to avoid missing intake of medication and follow up visits. Hypertensive patients should be advised to avoid smoking. PHC physicians should spend enough time with their hypertensive patients listening to their complaints and to meet patients' expectations of a consultation and to avoid any unnecessary over-prescription of multiple anti-hypertensive medications.