Non-adherence is a barrier to the control of hypertension. This study aimed to analyze the factors and interventions affecting adherence rates in the US.

PubMed, Scopus, Web of Science, and Embase were searched on January 21 st, 2022 for studies on the adherence to anti-hypertensives in the US. R software (4.2.1) and RevMan (5.4) were used for the analysis.

Our analysis showed that non-adherence to antihypertensives was higher in Hispanics compared with Blacks (OR= 1.25, p-value= 0.0335) with further analysis showing lower non-adherence rates among Whites compared with Blacks (OR= 0.63, p-value= 0.0049). Younger individuals had higher non-adherence rates (53%) compared with individuals older than 60 (46%), however, no statistically significant difference was detected between both groups. Unemployment was associated with decreased adherence (OR= 0.40, p-value< 0.00001), while gender and marital status yielded insignificant associations. Patients who suffered from multiple comorbidities (OR= 0.43, p-value= 0.004), depression (OR= 0.65, p-value <0.00001), and poor mental health (OR= 0.38, p-value< 0.00001) had lower adherence rates. Heavy alcohol consumption was associated with a decline in adherence, conversely, obesity didn't significantly affect the adherence rates. Regarding interventions, Fixed-dose combination had lower non-adherence rates compared with the control group (OR= 0.83, p-value= 0.0029), while telepharmacy didn't prove to be as effective. Lastly, exercise was associated with higher adherence (OR= 3.08, p-value< 0.00001).

Race and unemployment play a role in adherence to anti-hypertensives. Patients who suffer from depression, multiple comorbidities, and heavy alcohol intake had lower adherence rates. Accordingly, interventions such as fixed-dose combinations and exercise should be targeted at susceptible groups.