Medication Adherence and Antihypertensive Treatment Intensification on Blood Pressure Control at Bali Mandara Hospital

Authors

  • Desak Putu Meilinda Asri Swantari Faculty of Pharmacy Sanata Dharma University, Campus III Paingan, Maguwoharjo, Depok, Sleman Yogyakarta 55282, Indonesia Author
  • Dita Maria Virginia Faculty of Pharmacy Sanata Dharma University, Campus III Paingan, Maguwoharjo, Depok, Sleman Yogyakarta 55282, Indonesia Author
  • Phebe Hendra Faculty of Pharmacy Sanata Dharma University, Campus III Paingan, Maguwoharjo, Depok, Sleman Yogyakarta 55282, Indonesia Translator

DOI:

https://doi.org/10.24071/jpsc.v23i1.1067

Keywords:

Adherence, Blood pressure, Hypertension, Treatment intensification, MPR

Abstract

Controlling blood pressure (BP) in hypertension patients can reduce cardiovascular events. Efforts to improve BP control include enhancing medication adherence and intensifying antihypertensive treatment. This study aims to analyze the association of adherence and treatment intensification of antihypertensives with therapeutic outcomes among outpatients and assess the role of additional contributing factors. This retrospective cohort study at Bali Mandara Regional Hospital used patient medical records from April 2023 to March 2024. Subjects included outpatients on antihypertensive therapy, meeting inclusion and exclusion criteria. The independent variables were adherence, measured by Medication Possession Ratio (MPR), and treatment intensification, assessed based on the Treatment Intensification (TI) score. The dependent variable is a therapeutic outcome, BP, at the end of the study period. This study found a strong relationship between treatment intensification and improved BP control (p<0.05). However, there was no correlation between medication adherence and BP status. Patients with higher TI scores generally achieved better control over their BP. Individuals with TI scores < 0 had a 24 times higher chance of experiencing uncontrolled blood pressure compared to patients with higher TI scores. These findings highlight the critical role of treatment intensification in managing BP effectively.

References

Asamoah-Boaheng, M., Bonsu, K.O., Farrell, J., Oyet, A., Midodzi, W.K., 2021. Measuring medication adherence in a population-based asthma administrative pharmacy database: A systematic review and meta-analysis. Clinical Epidemiology, 13, 981–1010.

Biffi, A., Rea, F., Iannaccone, T., Filippelli, A., Mancia, G., Corrao, G., 2020. Sex differences in the adherence of antihypertensive drugs: a systematic review with meta-analyses. BMJ Open, 10(7), e036418.

Chiu, N., Chiu, L., Aggarwal, R., Raber, I., Bhatt, D.L., Mukamal, K.J., 2023. Trends in Blood Pressure Treatment Intensification in Older Adults with Hypertension in the United States, 2008 to 2018. Hypertension, 80(3), 553–562.

Defianna, S.R., Santosa, A., Probandari, A., Dewi, F.S.T., 2021. Gender Differences in Prevalence and Risk Factors for Hypertension among Adult Populations: A Cross-Sectional Study in Indonesia. International Journal of Environmental Research and Public Health, 18(12), 6259.

Du, L.P., Cheng, Z.W., Zhang, Y.X., Li, Y., Mei, D., 2018. The impact of fixed-dose combination versus free-equivalent combination therapies on adherence for hypertension: A meta-analysis. Journal of Clinical Hypertension, 20(5), 902–907.

Egan, B.M., Kjeldsen, S.E., Narkiewicz, K., Kreutz, R., Burnier, M., 2022. Single-pill combinations, hypertension control and clinical outcomes: potential, pitfalls and solutions. Blood Pressure, 31(1), 164–168.

Egan, B.M., Li, J., Sutherland, S.E., Rakotz, M.K., Wozniak, G.D., 2021. Hypertension Control in the United States 2009 to 2018: Factors Underlying Falling Control Rates During 2015 to 2018 Across Age- and Race-Ethnicity Groups. Hypertension, 78(3), 578–587.

Egbuchulem, K.I., 2022. How Confident Is the Confidence Interval. Annals of Ibadan postgraduate medicine, 20(2), 101–202.

Farnier, M., Santos, R.D., Cosin-Sales, J., Ezhov, M. V, Liu, J., Granados, D., Santoni, S., Khan, I., Catapano, A.L., 2022. Projected impact of treatment intensification with statin, ezetimibe, and statin plus ezetimibe fixed-dose combination on MACE across six countries. European Journal of Preventive Cardiology, 29(17), 2264–2271.

Fontil, V., Pacca, L., Bellows, B.K., Khoong, E., McCulloch, C.E., Pletcher, M., Bibbins-Domingo, K., 2022. Association of Differences in Treatment Intensification, Missed Visits, and Scheduled Follow-up Interval with Racial or Ethnic Disparities in Blood Pressure Control. JAMA Cardiology, 7(2), 204–212.

Jung, M., Lee, S., Youn, J., Chung, W., Ihm, S., Kang, Dongwoo, Kyoung, D., Jung, H.O., Chang, K., Youn, H., Lee, H., Kang, Danbee, Cho, J., Kaneko, H., Kim, H.C., 2023. Antihypertensive Medication Adherence and Cardiovascular Outcomes in Patients With Cancer: A Nationwide Population‐Based Cohort Study. Journal of the American Heart Association, 12(14), e029362.

Kassaw, A.T., Sendekie, A.K., Minyihun, A., Gebresillassie, B.M., 2024. Medication regimen complexity and its impact on medication adherence in patients with multimorbidity at a comprehensive specialized hospital in Ethiopia. Frontiers in Medicine, 11, 1369569.

Kemenkes RI, 2018. Badan Penelitian dan Pengembangan Kesehatan. Riset Kesehatan Dasar (RISKESDAS), Lembaga Penerbit Balitbangkes. Jakarta.

Kim, B.J., Cho, Y., Hong, K., Lee, J., Kim, J., Choi, K.H., Park, T.H., Park, S., Park, J., Kang, K., Lee, S.J., Kim, J.G., Cha, J., Kim, Dae‐Hyun, Lee, B., Yu, K., Oh, M., Kim, Dong‐Eog, Ryu, W., Choi, J.C., Kim, W., Shin, D., Sohn, S. Il, Hong, J., Lee, J.S., Lee, J., Han, M., Gorelick, P.B., Bae, H., 2021. Treatment Intensification for Elevated Blood Pressure and Risk of Recurrent Stroke. Journal of the American Heart Association, 10(7), e019457.

Kim, H.C., Cho, S.M.J., Lee, H., Lee, H.-H., Baek, J., Heo, J.E., 2021. Correction to: Korea hypertension fact sheet 2020: analysis of nationwide population-based data. Clinical Hypertension, 27(1), 10

Lee, H.J., Jang, S.-I., Park, E.-C., 2017. Effect of adherence to antihypertensive medication on stroke incidence in patients with hypertension: a population-based retrospective cohort study. BMJ Open, 7(6), e014486.

Levy, P.D., Willock, R.J., Burla, M., Brody, A., Mahn, J., Marinica, A., Nasser, S.A., Flack, J.M., 2016. Total antihypertensive therapeutic intensity score and its relationship to blood pressure reduction. Journal of the American Society of Hypertension, 10(12), 906–916.

Mancia, G., Rea, F., Corrao, G., Grassi, G., 2019. Two-Drug Combinations as First-Step Antihypertensive Treatment. Circulation Research, 124(7), 1113–1123.

Marinier, K., Macouillard, P., de Champvallins, M., Deltour, N., Poulter, N., Mancia, G., 2019. Effectiveness of two-drug therapy versus monotherapy as initial regimen in hypertension: A propensity score-matched cohort study in the UK Clinical Practice Research Datalink. Pharmacoepidemiology and Drug Safety, 28(12), 1572–1582.

Mathew, R.A., Johnson, S., Jose, S., Chakraborty, S., Kenneth, N., Gowda, V., 2018. A comparative study of monotherapy versus combination therapy in patients with stage-1 hypertension in terms of efficacy and cost effectiveness and to assess the medication adherence. International Journal of Research in Pharmaceutical Sciences, 9(1), 147–153.

Mayefis, D., Suhaera, Sari, Y.S., 2022. Hubungan Karakteristik Pasien Hipertensi Dengan Kepatuhan Minum Obat di UPT Puskesmas Meral Kabupaten Karimun Tahun 2020. SEHATMAS: Jurnal Ilmiah Kesehatan Masyarakat, 1(3), 266–278.

Mazza, A., Lenti, S., Schiavon, L., Sacco, A.P., Dell’Avvocata, F., Rigatelli, G., Ramazzina, E., 2017. Fixed-Dose Triple Combination of Antihypertensive Drugs Improves Blood Pressure Control: From Clinical Trials to Clinical Practice. Advances in Therapy, 34(4), 975–985.

Perhi, 2019. Konsensus Penatalaksanaan Hipertensi 2019, Indonesian Society Hipertensi Indonesia. Jakarta.

Pratiwi, V.D., Hendra, P., Virginia, D.M., 2024. Ketaatan Terapi Antihipertensi dengan Terkontrolnya Tekanan Darah pada Pasien Hipertensi Komorbid DM Tipe2 di Puskesmas Kabupaten Sleman. Jurnal Manajemen Kesehatan Yayasan RS.Dr. Soetomo, 10(1), 213-222.

Rose, A.J., Berlowitz, D.R., Manze, M., Orner, M.B., Kressin, N.R., 2009. Comparing Methods of Measuring Treatment Intensification in Hypertension Care. Circulation: Cardiovascular Quality and Outcomes, 2(4), 385–391.

Roumie, C.L., Zillich, A.J., Bravata, D.M., Jaynes, H.A., Myers, L.J., Yoder, J., Cheng, E.M., 2015. Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure. Stroke, 46(2), 465–470.

Sakima, A., Satonaka, H., Nishida, N., Yatsu, K., Arima, H., 2019. Optimal blood pressure targets for patients with hypertension: a systematic review and meta-analysis. Hypertension Research, 42(4), 483–495.

Selby, J. V., Uratsu, C.S., Fireman, B., Schmittdiel, J.A., Peng, T., Rodondi, N., Karter, A.J., Kerr, E.A., 2009. Treatment Intensification and Risk Factor Control. Medical Care, 47(4), 395–402.

Setiawan, C.H., Virginia, D.M., Pinaryanto, K., Sari, L.K., 2024. The impact of medication adherence on health outcomes for patients with metabolic syndrome. Jurnal Ilmu Kefarmasian Indonesia, 22(1), 87–94.

Siga, O., Wizner, B., Gryglewska, B., Walczewska, J., Grodzicki, T., 2019. Factors associated with intensification of antihypertensive drug therapy in patients with poorly controlled hypertension. Journal of Geriatric Cardiology, 16(1), 19–26.

Simatupang, A., Sitompul, F., Kurniaty, L., Djojosaputro, M., Lumbantobing, R., Silaban, H., 2022. Knowledge on Hypertension and its Therapy in Lay People. Indonesian Journal of Pharmacology and Therapy, 3(3), 100–106.

Sperber, C.M., Samarasinghe, S.R., Lomax, G.P., 2017. An upper and lower bound of the Medication Possession Ratio. Patient Preference and Adherence, 11, 1469–1478.

Suhadi, R., Atthobari, J., Irawan, B., Dwiprahasto, I., 2013. Hubungan Faktor Komorbiditas, Intensifikasi Terapi, Dan Pengendalian Tekanan Darah. Jurnal Farmasi Komunitas, 10(1693–5683), 1–8.

Suhadi, R., Hendra, P., Wijoyo, Y., Virginia, D.M., Setiawan, C.H., 2016. Seluk Beluk Hipertensi: Peningkatan Kompetensi Klinis Untuk Pelayanan Kefarmasian. Sanata Dharma University Press, Yogyakarta.

Tan, M.S., Kim, K., Olsen, C.J., Brixner, D.I., 2023. Effect of treatment intensification on glycemic control in patients with subcontrolled type 2 diabetes who failed on two oral antidiabetic agents. Diabetes Epidemiology and Management, 9, 100127.

Tang, K.L., Quan, H., Rabi, D.M., 2017. Measuring medication adherence in patients with incident hypertension: a retrospective cohort study. BMC Health Services Research, 17(1), 1–16.

Tasić, I., Kostić, S., Stojanović, N.M., Djordjević, D., Bogdanović, D., Deljanin Ilić, M., Lović, M., Stoičkov, V., Aleksandrić, S., 2020. Predictors of cardiovascular events in hypertensive patients with high cardiovascular risk. Medicina (Lithuania), 56(4), 182.

Tenny, S., Hoffman, M.R., 2024. Odds Ratio [Updated 2023 May 22], in: StatPearls [Internet]. StatPearls Publishing, Treasure Island (FL).

Usherwood, T., 2024. Therapeutic inertia. Australian Prescriber, 47(1), 15–19.

Verma, A.A., Khuu, W., Tadrous, M., Gomes, T., Mamdani, M.M., 2018. Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study. PLoS Medicine, 15(6), e1002584.

Wang, B., Choudhry, N.K., Gagne, J.J., Landon, J., Kesselheim, A.S., 2015. Availability and utilization of cardiovascular fixed-dose combination drugs in the United States. American Heart Journal, 169(3), 379-386.e1.

Xu, W., Goldberg, S.I., Shubina, M., Turchin, A., 2015. Optimal systolic blood pressure target, time to intensification, and time to follow-up in treatment of hypertension: Population based retrospective cohort study. BMJ (Online), 350.

Zaman, M.A., Awais, N., Satnarine, T., Ahmed, A., Haq, A., Patel, D., Gutlapalli, S.D., Hernandez, G.N., Seffah, K., Khan, S., 2023. Comparing Triple Combination Drug Therapy and Traditional Monotherapy for Better Survival in Patients With High-Risk Hypertension: A Systematic Review. Cureus, 15(7), e41398.

Zhu, V.J., Tu, W., Rosenman, M.B., Overhage, J.M., 2014. A Comparison of Data Driven-based Measures of Adherence to Oral Hypoglycemic Agents in Medicaid Patients. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2014, 1294–1301.

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Published

2026-06-12

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How to Cite

Medication Adherence and Antihypertensive Treatment Intensification on Blood Pressure Control at Bali Mandara Hospital. (2026). Jurnal Farmasi Sains Dan Komunitas (Journal of Pharmaceutical Sciences and Community), 23(1), 35-44. https://doi.org/10.24071/jpsc.v23i1.1067