Document Type : Meta-analysis


1 Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

2 Associate Professor, Iranian Research Center on Aging AND Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

3 Associate Professor, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

4 Professor, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

5 Professor, Behavioral Sciences Research Center, Lifestyle Institute, School of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran


BACKGROUND: Medication adherence (MA) has a crucial role in controlling of hypertension (HTN). A difference was observed in the prevalence of anti-hypertensive MA reported in different studies in Iran, so we aimed to determine the overall prevalence of MA.METHODS: Using the English and Persian keywords extracted from Mesh, the databases of MagIran, Barakat Knowledge Network System, Scientific Information Database (SID), Web of Sciences, PubMed, Science Direct, and Google Scholar were reviewed from 2000 to 2018. The overall prevalence of MA was estimated using Random effect mode. The I2 and Egger’s tests were used to assess heterogeneity and publication bias, respectively. Meta-regression and subgroup analysis were conducted based on variables such as age, marital status, regions, and tools.RESULTS: The overall prevalence of MA was 33%. Moreover, the prevalence of MA based on ‎the 8-Item Morisky Medication Adherence Scale‎ (MMAS-8), Hill-Bone Medication Adherence (HBMA) scale, researcher-made tools, and self-care tools, were 13%, 34%, 48%, and 47%, respectively. A higher MA prevalence (38%) was observed among older adults compared to other age groups, and married patients (32%) compared to single (23%) individuals. The highest MA prevalence (50%) was related to region 5 of the country. Meta-regression results showed a significant relationship between the used tools and MA prevalence.CONCLUSION: The overall prevalence of MA is low in Iran. Furthermore, MA was measured using different questionnaires, such as standard international scales and researcher-made tools. It is proposed that a standard international questionnaire should be used in future studies. 


  1. Slone Epidemiology Center BU. Patterns of medication use in the United States 2006 [Online]. [cited 2006]; Available from: URL:
  2. Yassine M, Al-Hajje A, Awada S, Rachidi S, Zein S, Bawab W, et al. Evaluation of medication adherence in Lebanese hypertensive patients. J Epidemiol Glob Health 2016; 6(3): 157-67.
  3. Ikeda N, Sapienza D, Guerrero R, Aekplakorn W, Naghavi M, Mokdad AH, et al. Control of hypertension with medication: A comparative analysis of national surveys in 20 countries. Bull World Health Organ 2014; 92(1): 10-19C.
  4. Wang TJ, Vasan RS. Epidemiology of uncontrolled hypertension in the United States. Circulation 2005; 112(11): 1651-62.
  5. Su TC, Bai CH, Chang HY, You SL, Chien KL, Chen MF, et al. Evidence for improved control of hypertension in Taiwan: 1993-2002. J Hypertens 2008; 26(3): 600-6.
  6. Malekzadeh MM, Etemadi A, Kamangar F, Khademi H, Golozar A, Islami F, et al. Prevalence, awareness and risk factors of hypertension in a large cohort of Iranian adult population. J Hypertens 2013; 31(7): 1364-71.
  7. Shaw R, Bosworth HB. Baseline medication adherence and blood pressure in a 24-month longitudinal hypertension study. J Clin Nurs 2012; 21(9-10): 1401-6.
  8. Black HR, Elliott WJ, Neaton JD, Grandits G, Grambsch P, Grimm RH Jr, et al. Baseline characteristics and early blood pressure control in the CONVINCE trial. Hypertension 2001; 37(1): 12-8.
  9. Burnier M. Managing 'resistance': Is adherence a target for treatment? Curr Opin Nephrol Hypertens 2014; 23(5): 439-43.
  10. Morrison VL, Holmes EA, Parveen S, Plumpton CO, Clyne W, De Geest S, et al. Predictors of self-reported adherence to antihypertensive medicines: A multinational, cross-sectional survey. Value Health 2015; 18(2): 206-16.
  11. Conn VS, Ruppar TM, Chase JA, Enriquez M, Cooper PS. Interventions to improve medication adherence in hypertensive patients: Systematic review and meta-analysis. Curr Hypertens Rep 2015; 17(12): 94.
  12. Christensen A, Osterberg LG, Hansen EH. Electronic monitoring of patient adherence to oral antihypertensive medical treatment: A systematic review. J Hypertens 2009; 27(8): 1540-51.
  13. Dragomir A, Cote R, Roy L, Blais L, Lalonde L, Berard A, et al. Impact of adherence to antihypertensive agents on clinical outcomes and hospitalization costs. Med Care 2010; 48(5): 418-25.
  14. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol 2009; 62(10): e1-34.
  15. Chalmers J, MacMahon S, Mancia G, Whitworth J, Beilin L, Hansson L, et al. 1999 World Health Organization-international society of hypertension guidelines for the management of hypertension. guidelines sub-committee of the World Health Organization. Clin Exp Hypertens 1999; 21(5-6): 1009-60.
  16. Hoodin F, Weber S. A systematic review of psychosocial factors affecting survival after bone marrow transplantation. Psychosomatics 2003; 44(3): 181-95.
  17. Ghanei Gheshlagh R, Nazari M, Baghi V, Dalvand S, Dalvandi A, Sayehmiri K. Underreporting of needlestick injuries among healthcare providers in Iran: A systematic review and meta-analysis. Hayat 2017; 23(3): 201-13.
  18. Ghanei GR, Sayehmiri K, Ebadi A, Dalvandi A, Dalvand S, Nourozi TK. Resilience of patients with chronic physical diseases: A systematic review and meta-analysis. Iran Red Crescent Med J 2016; 18(7): e38562.
  19. Tsimicalis A, Stinson J, Stevens B. Quality of life of children following bone marrow transplantation: Critical review of the research literature. Eur J Oncol Nurs 2005; 9(3): 218-38.
  20. Eosaltay N, Karadas E. Introduction to meta-analysis. In: Karadag E, Editor. Leadership and organizational outcomes: meta-analysis of empirical studies. Berlin, Germany: Springer; 2015. p. 19-28.
  21. Zinat Motlagh SF, Chaman R, Sadeghi E, Eslami AA. Self-care behaviors and related factors in hypertensive patients. Iran Red Crescent Med J 2016; 18(6): e35805.
  22. Barati M, Darabi D, Moghimbeigi A, Afsar A. Self-regulation behaviors of hypertension and related factors among hypertensive patients. J Fasa Univ Med Sci 2011; 1(3): 116-22. [In Persian].
  23. Mahmoudian A, Zamani A, Tavakoli N, Farajzadegan Z, Fathollahi-Dehkordi F. Medication adherence in patients with hypertension: Does satisfaction with doctor-patient relationship work? J Res Med Sci 2017; 22: 48.
  24. Najimi A, Mostafavi F, Sharifirad G, Golshiri P. Barriers to adherence to pharmacotherapy among patients with hypertension: A cross-sectional study. International Journal of Medical Research & Health Sciences 2016; 5(7): 47-53. [In Persian].
  25. Asayeshi F, Mostafavi F, Hassanzadeh A. The relation between medication-related beliefs and treatment adherence in patients with hypertension in urban health care centers in Isfahan, Iran. J Health Syst Res 2017; 13(1): 32-7. [In Persian].
  26. Behnood-Rod A, Rabbanifar O, Pourzargar P, Rai A, Saadat Z, Saadat H, et al. Adherence to antihypertensive medications in Iranian patients. Int J Hypertens 2016; 2016: 1508752.
  27. Saadat Z, Nikdoust F, Aerab-Sheibani H, Bahremand M, Shobeiri E, Saadat H, et al. Adherence to antihypertensives in patients with comorbid condition. Nephrourol Mon 2015; 7(4): e29863.
  28. Taher M, Abredari H, Karimy M, Abedi A, Shamsizadeh M. The relation between social support and adherence to the treatment of hypertension. J Educ Community Health 2014; 1(3): 63-9.
  29. Arbabshastan ME, Iranmanesh S, Dehghan M. An analytical assessment of medication adherence among patients with hypertension. Der Pharmacia Lettre 2016; 8(5): 98-104.
  30. Dehghan M, Nayeri ND, Iranmanesh S. Validating the persian version of the hill-bone's scale of "compliance to high blood pressure therapy"Journal of Advances in Medicine and Medical Research 2015; 5(2): 235-46. [In Persian].
  31. Izadirad H, Zareban I. Assessment of Knowledge, treatment and blood pressure control in hypertensive patients. Journal of Health Literacy 2016; 1(1): 61-6. [In Persian].
  32. Masror Roudsari D, Dabiri Golchin M, Parsa yekta Z, Haghani H. Relationship between adherence to therapeutic regimen and health related quality of life in hypertensive patients. Iran J Nurs 2013; 26(85): 44-54. [In Persian].
  33. Hadi N, Rostami Gouran N. Determinant factors of medication compliance in hypertensive patients of Shiraz, Iran. Arch Iran Med 2004; 7(4): 292-6.
  34. [In Persian].
  35. Kamran A, Sadeghieh Ahari S, Biria M, Malepour A, Heydari H. Determinants of patient's adherence to hypertension medications: Application of health belief model among rural Patients. Ann Med Health Sci Res 2014; 4(6): 922-7.
  36. Moharamzad Y, Saadat H, Nakhjavan Shahraki B, Rai A, Saadat Z, Aerab-Sheibani H, et al. Validation of the Persian version of the 8-item morisky medication adherence scale (MMAS-8) in Iranian hypertensive patients. Glob J Health Sci 2015; 7(4): 173-83.
  37. Roohafza H, Kabir A, Sadeghi M, Shokouh P, Ahmadzad-Asl M, Khadem-Maboudi AA, et al. Stress as a risk factor for noncompliance with treatment regimens in patients with diabetes and hypertension. ARYA Atheroscler 2016; 12(4): 166-71.
  38. Taher M, Safavi Bayat Z, Niromand Zandi K, Ghasemi E, Abredari H, Karimy M, et al. Correlation between compliance regimens with health locus of control in patients with hypertension. Med J Islam Repub Iran 2015; 29: 194.
  39. Nielsen JO, Shrestha AD, Neupane D, Kallestrup P. Non-adherence to anti-hypertensive medication in low-and middle-income countries: A systematic review and meta-analysis of 92443 subjects. J Hum Hypertens 2017; 31(1): 14-21.
  40. Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs: A systematic review and
  41. meta-analysis. Medicine (Baltimore) 2017; 96(4): e5641.
  42. Durand H, Hayes P, Morrissey EC, Newell J, Casey M, Murphy AW, et al. Medication adherence among patients with apparent treatment-resistant hypertension: Systematic review and meta-analysis. J Hypertens 2017; 35(12): 2346-57.
  43. Al-Ramahi R. Adherence to medications and associated factors: A cross-sectional study among Palestinian hypertensive patients. J Epidemiol Glob Health 2015; 5(2): 125-32.
  44. Lemstra M, Alsabbagh MW. Proportion and risk indicators of nonadherence to antihypertensive therapy: A meta-analysis. Patient Prefer Adherence 2014; 8: 211-8.
  45. Tong X, Chu EK, Fang J, Wall HK, Ayala C. Nonadherence to antihypertensive medication among hypertensive adults in the united states horizontal line healthstyles, 2010. J Clin Hypertens (Greenwich) 2016; 18(9): 892-900.
  46. Lo SH, Chau JP, Woo J, Thompson DR, Choi KC. Adherence to antihypertensive medication in older adults with hypertension. J Cardiovasc Nurs 2016; 31(4): 296-303.
  47. Jackson D. A Myriad of multiples: Many problematic factors contribute to medication non-adherence in elders. Generations 2011; 35(4):
  48. -6.
  49. Marcum ZA, Driessen J, Thorpe CT, Gellad WF, Donohue JM. Effect of multiple pharmacy use on medication adherence and drug-drug interactions in older adults with Medicare Part D. J Am Geriatr Soc 2014; 62(2): 244-52.
  50. Ortman JM, Velkoff VA, Hogan H. An aging nation: The older population in the United States. Suitland-Silver Hill, MD: United States Census Bureau; 2014.