Predictors of Antihypertensive Drug Adherence and Blood Pressure Control Among Hypertensive Patients: A Multicenter Cross‐Sectional Study

<b>Background:</b> Hypertension or elevated blood pressure is a serious medical condition that significantly increases the risk of diseases of the heart, brain, kidneys, and other organs. Antihypertensive drug adherence is key to controlling blood pressure. This study aimed to assess factors associated with antihypertensive drug adherence and blood pressure control among hypertensive patients in selected public hospitals under the Addis Ababa City Administration. <b>Method:</b> A hospital-based cross-sectional study was conducted among hypertensive patients on follow-up in randomly selected public hospitals under the Addis Ababa City Administration from November 1, 2022, to February 28, 2023. The study population included 393 patients who fulfilled the eligibility criteria and were selected by systematic random sampling. Data collection was conducted from the electronic medical records and by interviewing patients with a structured questionnaire. The data were entered into Epi-Info 7.2.1 and exported to SPSS version 25 software for analysis. Logistic regression analysis was performed to determine the associations between the dependent and independent variables. <b>Results:</b> The rates of antihypertensive drug adherence and blood pressure control were 72.5% and 23.4%, respectively. Participants with uncontrolled blood pressure were 41.7% less adherent than those with controlled blood pressure (AOR = 0.59; 95% CI, 0.36-0.97). Nonadherence to dietary restriction (AOR, 3.31; 95% CI, 1.84-5.96) and chronic kidney disease (AOR = 3.85; 95% CI, 1.41-10.52) were associated with good adherence, whereas the use of a single antihypertensive drug (AOR = 0.53; 95% CI, 0.30-0.94) and nonadherence to moderate physical exercise (AOR = 0.30; 95% CI, 0.20-0.65) were associated with poor adherence to antihypertensive medications. Male sex (AOR = 1.95; 95% CI, 1.04-3.28) and blood pressure measured at home (AOR = 0.59; 95% CI, 0.36-0.99) were found to be independent predictors of controlled blood pressure. Drinking alcohol (AOR = 1.92; 95% CI, 1.05-3.49) was inversely associated with blood pressure control. <b>Conclusion:</b> Although adherence to antihypertensive medications was relatively good, blood pressure control remained low, indicating that medication adherence alone is insufficient. Public health policies should focus on strengthening primary care systems to deliver integrated hypertension management, including lifestyle counseling, dietary support, and improved access to medications and monitoring tools.