title: Predictors of Medication Adherence and Blood Pressure Control among Saudi Hypertensive Patients Attending Primary Care Clinics: A Cross-Sectional Study.
abstract: OBJECTIVE
  To assess the level of medication adherence and to investigate predictors of medication adherence and blood pressure control among hypertensive patients attending primary healthcare clinics in Makkah, Saudi Arabia.
  
  
  METHODS
  Hypertensive patients meeting the eligibility criteria were recruited from eight primary care clinics between January and May 2016 for this study. The patients completed Arabic version of Morisky Medication Adherence Scale (MMAS-8), an eight-item validated, self-reported measure to assess medication adherence. A structured data collection form was used to record patients' sociodemographic, medical and medication data.
  
  
  RESULTS
  Two hundred and four patients, of which 71.6% were females, participated in the study. Patients' mean age was 59.1 (SD 12.2). The mean number of medication used by patients was 4.4 (SD 1.89). More than half (110; 54%) of the patients were non-adherent to their medications (MMAS score < 6). Binary regression analysis showed that highly adherent patients (MMAS score = 8) were about five times (OR 4.91 [95%CI: 1.85-12.93; P = 0.01]) more likely to have controlled blood pressure compared to low adherent patients. Female gender (OR 0.40 [95% CI: 0.20-0.80; P = 0.01]), Age > 65 years (OR 2.0 [95% CI: 1.0-4.2; P = 0.04]), and being diabetic (OR 0.25 [95% CI: 0.1-0.6; P = 0.04]) were found to be independent predictors of medication adherence.
  
  
  CONCLUSIONS
  Medication adherence is alarmingly low among hypertensive patients attending primary care clinics in Saudi Arabia which may partly explain observed poor blood pressure control. There is a clear need to educate patients about the importance of medication adherence and its impact on improving clinical outcomes. Future research should identify barriers to medication adherence among Saudi hypertensive patients.
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Khayyat
authors.affiliation: Public Health Centers, Ministry of Health, Makkah, Saudi Arabia.
authors.forename: Salwa M Saeed
authors.initials: SM
authors.lastname: Khayyat
authors.affiliation: Public Health Centers, Ministry of Health, Makkah, Saudi Arabia.
authors.forename: Raghda S
authors.initials: RS
authors.lastname: Hyat Alhazmi
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia.|Pharmaceutical Research Center, Deanship of Scientific Research, Umm Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Mahmoud M A
authors.initials: MM
authors.lastname: Mohamed
authors.affiliation: School of Healthcare, University of Leeds, Leeds, United Kingdom.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Abdul Hadi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011320:Primary Health Care; D012529:Saudi Arabia; D011795:Surveys and Questionnaires; D055815:Young Adult