RELIGIOSITY AND MEDICATION ADHERENCE IN INDIVIDUALS WITH RESISTANT HYPERTENSION: THE SOUL STUDY

Objective: Poor medication adherence (PA) is a major barrier to effective blood pressure control and remains the leading cause of resistant hypertension (RH). Increasing attention has been directed toward behavioural markers of PA, including religiosity and spirituality, linked to improved adherence to antihypertensive treatment. However, the role of religiosity in PA among individuals with RH is still unexplored. We aimed to study the association between religiosity and PA in patients with RH, investigating its interplay with mental health and lifestyle.Design and method: SOUL was a cross-sectional study of individuals with RH attended at tertiary hypertension unit. Adherence to antihypertensive medication was assessed using the Morisky-4 Medication Adherence Scale (MMAS-4), categorizing patients as highly (score = 0) or poorly (score = 4) adherent. The two groups were then compared in terms of religiosity, moral qualities, depressive symptoms, and lifestyle. Organizational, Non-Organizational, and Intrinsec Religiosity was assessed using the Duke University Religion Index (DUREL). Low Religiosity was defined by the lowest decile of the DUREL score, including individuals with a total score less than or equal to 15. For comparisons of quantitative variables between groups, non-parametric Mann-Whitney tests were used. Chi-squared and Fisher’s exact tests were used for qualitative variables. Linear regressions were conducted using the Ordinary Least Squares (OLS) method. Results: A total of 148 participants (59% female; mean age 62 ± 5.4 years) with RH (under 3.9 ± 0.2 classes of antihypertensive medications) were categorized as highly adherent (HA; n=78) or poorly adherent (PA; n=70). The mean scores for religiosity (p=0.769), compassion (p=1.0), gratitude (p= 0.852), and forgiveness (p=0.092) were similar between HA and PA groups. After adjustment by sex and age, low religiosity was a strong predictor of being PA (Organizational: OR 11.38, p=0.07; Non-Organizational: OR not calculable, p=0.022; Intrinsic: OR 7.23, p=0.053). Depressive symptoms (median BDI: 21 vs. 12; p=0.015), sleep quality (p<0.001), and physical activity (p<0.001) were also associated with PA. Conclusions: In this sample of RH patients, low religiosity was strongly associated with PA, as well as depressive symptoms, sleep quality and physical inactivity. Moral qualities were not predictive of PA.