Clinical Implementation of the Hill-Bone Compliance to High Blood Pressure Therapy Scale: Antihypertensive Adherence Assessment in a Romanian Cardiology Outpatient Center

Radu Tatar,1,2 Marius Stefan Marusteri,2 Liviu Cristescu,1 Anca-Paula Sulea,1,2 Andreea Varga,3 Ioan Tilea2 1Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania; 2Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania; 3Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, RomaniaCorrespondence: Andreea Varga, Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu st, Targu Mures, Romania, Email [email protected]: To evaluate antihypertensive therapy adherence and to validate the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBCTS) for implementation in Romanian cardiology outpatient practice.Patients and Methods: In this cross-sectional pilot study, 144 adult hypertensive patients completed a Romanian-translated, culturally adapted HBCTS. Mean arterial pressure (MAP) served as an indicator of blood pressure control. Receiver operating characteristic (ROC) analysis determined the optimal adherence cut-off, and multivariable modelling assessed the relationship between HBCTS scores and MAP, adjusting for potential confounders. This study was conducted at an outpatient cardiology clinic in Targu Mureș, Romania, Patients inclusion criteria: adult patients (≥ 18 years) with diagnosed primary hypertension receiving at least one year of continuous antihypertensive therapy, and exclusion criteria: cognitive/communication barriers and secondary hypertension.Results: The HBCTS demonstrated acceptable internal consistency (McDonald’s ω = 0.75; Cronbach’s α = 0.70) and retained a three-factor structure. ROC analysis identified 50 points as the optimal adherence threshold (AUC = 0.81; sensitivity = 0.83; specificity = 0.57). After adjustment, 52.1% of participants met the adherence criterion. Each one-point increase in HBCTS score corresponded to a 35% increase in the odds of achieving controlled blood pressure (OR = 1.35; 95% CI: 1.19– 1.53; p < 0.001). Older age was associated with lower probability of adherence (OR = 0.94; 95% CI: 0.89– 0.98, p = 0.006), whereas permanent employment status increased the chance of higher adherence (OR = 3.36; 95% CI: 1.57– 7.22, p = 0.002). Patients overreported their adherence by 18.5% compared with MAP-defined blood pressure control.Conclusion: These findings support the applicability of the HBCTS in Romanian cardiology outpatient settings and identify key demographic factors associated with patient’s adherence. The validated scale offers cardiology practitioners a reliable instrument to detect adherence barriers among high-risk patients, thereby supporting the implementation of targeted, patient-centered interventions.Keywords: hypertension, medication adherence, hill-bone compliance to high blood pressure therapy scale, mean arterial pressure, outpatient cardiology center