Patient perceptions, motivations and barriers to treatment adherence in hypertension: results of a questionnaire-based survey in five European countries

To assess perceptions, motivations and barriers to treatment adherence depending on emotional, lifestyle, medical and non-adherence risk profiles in hypertensive patients. Cross-sectional data were obtained using an online anonymous survey. Four distinct global risk scores (medical, lifestyle, emotional and quality of life (QoL) and non-adherence risk scores) were calculated based on the responses to specific groups of questions. A total of 2615 treated hypertensive patients (≥18 years of age) from 5 European countries completed the questionnaire. Mean (SD) age was 69.6 years (5.8); 54% males. Overall, antihypertensive therapy represented a low burden in patients’ daily life (2.9/10 in the Likert scale). Perfect self-reported adherence was claimed by 59.8% of participants. Reporting of non-adherence episodes to physicians was low (13% always/often). Participants with a high non-adherence risk score had a greater number of associated diseases (obesity, sleep disturbances, depression and cardiac complications), a higher treatment-associated burden on daily life, a greater stress level and more antihypertensive pills per day (<i>p</i> &lt; 0.001 for all). No correlation was found between the clinical and lifestyle risk scores and the risk of non-adherence. The emotional score correlated significantly with the non-adherence risk score (<i>p</i> &lt; 0.001). Comparing patients with a low/middle risk to those with a high risk of non-adherence, female gender and age &gt;65 years were associated with a lower odd ratio of non-adherence whereas depression, stress, family hardships, negative information on drugs and poor information were associated with higher odds of non-adherence. This large survey reveals several underestimated issues regarding patients’ perspective in hypertension. It highlights the impact of emotions, exposure to family hardships, and stress on the risk of non-adherence. Non-adherence is underreported by patients; hence it remains mostly unrecognised. A good knowledge of patients’ perception, beliefs, motivations and barriers to antihypertensive treatment adherence is essential to improve blood pressure (BP) control in the population.In this large survey conducted in five European countries, we assessed patients according to their medical, emotional, lifestyle and non-adherence risk profiles.Results show that emotional aspects and exposure to family hardships have a significant impact on the risk of non-adherence.Moreover, a poor adherence to medications remains often unknown because patients do not report their difficulties to their physicians. A good knowledge of patients’ perception, beliefs, motivations and barriers to antihypertensive treatment adherence is essential to improve blood pressure (BP) control in the population. In this large survey conducted in five European countries, we assessed patients according to their medical, emotional, lifestyle and non-adherence risk profiles. Results show that emotional aspects and exposure to family hardships have a significant impact on the risk of non-adherence. Moreover, a poor adherence to medications remains often unknown because patients do not report their difficulties to their physicians.