Adherence to the pharmacological treatment of systemic arterial hypertension in elderly patients in primary health care

Abstract

Systemic arterial hypertension (SAH) is one of the most prevalent non-communicable chronic diseases worldwide, affecting approximately 1.13 billion people in 2015, with a significant increase over the past 40 years, especially in low- and middle-income countries. In Brazil, SAH affects about 32.3% of the adult population and up to 71.7% of individuals over 70 years old, being responsible for 45% of cardiac deaths and 51% of deaths from cerebrovascular diseases. Poorly controlled SAH is directly associated with a higher risk of complications such as stroke, acute myocardial infarction, and chronic kidney failure. Primary health care (PHC) plays a fundamental role in recognizing, treating, and monitoring these patients but faces challenges regarding adherence to medication therapy. This study aims to analyze the multiple dimensions involved in medication adherence for SAH in elderly individuals in PHC, considering the factors influencing this adherence and the strategies adopted to promote it. A narrative literature review was conducted with a systematic search in the LILACS, SciELO, MEDLINE/PubMed, and Google Scholar databases. The Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) were used, including "Elderly," "Systemic Arterial Hypertension," "Treatment Adherence," and "Primary Health Care," combined with the Boolean operators AND and OR. The literature review revealed that low adherence to medication therapy for SAH in elderly individuals varies between 30% and 50%, according to different studies conducted in Brazil and worldwide. A study carried out in a Family Health Strategy (FHS) unit in Cuiabá, MT, found that none of the 54 users studied fully adhered to the proposed treatment; 50% adhered partially, and 50% did not adhere at all. Internationally, research indicates that up to 35% of hypertensive patients discontinue medication use within the first year of treatment. The main factors impacting treatment adherence are divided into five dimensions: (1) patient-related factors, including educational level, age group, family support, and perception of disease severity; (2) health system-related factors, such as difficulty accessing consultations and medications, poor doctor-patient relationships, and reduced consultation time; (3) socioeconomic factors, including low income and high medication costs; (4) treatment-related factors, such as the complexity of therapeutic regimens and adverse medication effects; and (5) disease-related factors, including the absence of noticeable symptoms in the early stages of SAH, which reduces the patient's risk perception. To improve treatment adherence, several strategies are recommended, including: (1) the inclusion of clinical pharmacists in PHC, providing patient follow-up and educational support; (2) strengthening the role of community health agents, promoting home visits for continuous monitoring; (3) the use of technology, such as mobile applications, SMS reminders, and telemonitoring to reinforce regular medication use; and (4) expanding access to free or subsidized medications, as seen in the "Farmácia Popular" Program, which has benefited millions of hypertensive patients in Brazil since its implementation in 2004.