Global Prevalence of Adherence to Antihypertensives and Associated Moderating Factors Among Adults With Hypertension: A Meta‐Analysis

BACKGROUND: Hypertension is a significant public health issue affecting over a billion adults worldwide with adherence to antihypertensives being crucial for achieving sustained blood pressure control and reducing cardiovascular morbidity and mortality. To extend previous evidence, we conducted a meta-analysis on global prevalence of adherence to antihypertensives among adults. METHODS: statistics examined statistical heterogeneity with moderator analysis exploring sources of heterogeneity. Sensitivity analysis was analyzed using exact fixed-effects model. RESULTS: A total of 123 studies with 1 052 445 adults with hypertension were included. Pooled global prevalence of adherence to antihypertensives was estimated at 58% (95% CI, 52%-63%), with 39% for high adherence, 29% for moderate adherence, and 35% for low adherence. Results for sensitivity analysis were 57.91% (95% CI, 57.81%-58.01%) with δ̂ being 24.3%. Prevalence across continents was 67% for Europe, 65% for South America, 60% for Africa, 56% for Asia, and 45% for North America. Adherence to antihypertensives was similar across low-income countries (61%), high-income countries (58), upper-middle-income countries (57%), and lower-middle-income countries (56%). In multivariate model, age and assessment tool only were significantly associated with medication adherence. CONCLUSIONS: Globally, a large proportion of adults with hypertension exhibit moderate to low adherence to antihypertensive medications. Future studies should prioritize establishing consensus-based operational definitions and cutoff values to enhance adherence.