Nonadherence and uncontrolled arterial hypertension in Croatia—Insights from the May Measurement Month 2023 campaign and Hunting the silent killer programme

Abstract

Aims: To determine the prevalence of non-adherence to antihypertensive medicines and to identify demographic and behavioral factors associated with non-adherence in subjects enrolled in the May Measurement Month (MMM) 2023, as part of the permanent public health action Hunting the silent killer. Methods: In this cross-sectional opportunistic screening, the original MMM questionnaire was extended by adding questions related to salt intake, mobile phones, and adherence, which was assessed using the validated 5-item Medication Adherence Report Scale (scores ≥23 indicating adherence). Out of 10 488 subjects enrolled in MMM 2023 in Croatia, this analysis included 8739 subjects who were enrolled in 329 community pharmacies and had three BP measurements using the same device. Results: Among 4964 HT participants, 68.2% were adherent. Non-adherence was more common among men, urban residents, and younger individuals. Female sex (OR = 1.29) and rural residence (OR = 1.21) were associated with higher adherence. Non-adherence was significantly associated with poorer BP control (p < 0.05). Forgetfulness and missing doses were the most frequently reported behaviors. Conclusion: Nearly one-third of HT patients in Croatia are nonadherent to prescribed medicines, contributing to suboptimal BP control. Routine adherence screening and tailored interventions, particularly for younger men and urban dwellers, are urgently needed to improve cardio-kidney-metabolic outcomes.