medication and hypertension management


Tan CS, Hassali MA, Neoh CF, Saleem F. A qualitative exploration of hypertensive patients’ perception towards quality use of medication and hypertension management at the community level. Pharmacy Practice 2017 Oct-Dec;15(4):1074. (eISSN: 1886-3655 ISSN: 1885-642X) 1


Abstract Objective: This study aimed to explore hypertensive patients’ perspectives on quality use of medication and issues related to hypertension management at the community level in Malaysia. Methods: Focus groups discussion was employed in this qualitative study. A total of 17 hypertensive patients were purposively recruited. Three focus group discussions with semi-structured interview were carried out at Flat Desa Wawasan, Penang. All the conversations were audio recorded, transcribed verbatim and thematically analysed. Results: Three major themes were developed, including medication adherence among hypertensive patients, self-management of hypertension and patients’ knowledge towards hypertension. Poor medication adherence was found and different strategies were taken to overcome the barriers towards adherence. Use of herbal and traditional therapies was perceived as alternative method in controlling blood pressure instead of taking antihypertensive medication. The participants were found to have poor knowledge on side effect and mechanism of action of hypertensive medication. Conclusions: The misconception about the side effect of antihypertensive medication has led to poor adherence among the participants. Lack of knowledge on targeted blood pressure level has led to poor blood pressure monitoring among the participants. Health awareness program and counselling from health care professional should be advocated among the hypertensive patients in addressing the above gaps.

Keywords Hypertension; Medication Adherence; Patient Medication Knowledge; Health Knowledge, Attitudes, Practice; Focus Groups; Qualitative Research; Malaysia


Hypertension is one of the renowned risk factors contributing to cardiovascular disease, including stroke, arrhythmias, coronary heart disease and myocardial infarction.

1 About 1.39 billion adults worldwide were

diagnosed with hypertension 2 in 2010 and the number is

predicted to increase to 1.56 billion by year 2025. 3 More

than half of the hypertensive patients were unable to achieve well-controlled blood pressure level despite the recent advancement in the antihypertensive treatment.


Poor medication adherence is one of the contributing factors that caused uncontrolled blood pressure level among hypertensive patients.

5-7 The rate of medication

adherence in many developing countries including Malaysia was reported lower when compared to developed countries.


Likewise, in 2015, 30.3% of the Malaysian adults (i.e. 18 years and above) had hypertension, with 13.1% of known hypertension and 17.2% of undiagnosed hypertension.

12 Of

note, only 26.8% of these hypertensive patients had their blood pressure under control

13 and up to 46.6% of them

were reported to have poor medication adherence. 14

A recent local study revealed that a total of 20,799 excessive pills were returned by hypertensive patients at a single Malaysian government hospital, with a total cost of (Malaysian Ringgit) MYR 4,362.28 (equal to USD 1037) was wasted during the 8 months of study period with an average wastage of MYR 42.35 (equal to USD 10) per patient; changing medication by the doctor and death of patients were the most common reasons accounted for the wastage.


Low rate of adherence to antihypertensive medication has significantly increased blood pressure and was associated with higher rate of hospitalization and mortality.

16 Previous

studies have found that many hypertensive patients did not adhere to antihypertensive medication because they had wrong perception towards hypertension or they were unconfident with their antihypertensive medication such as concern of potential adverse effects.

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