Researchers in Morocco studied 200 people with high blood pressure to understand why they don’t stick with their treatment plans. They found that only about 40% of patients follow healthy lifestyle changes like eating better and exercising, and nearly 60% don’t take their blood pressure medications as prescribed. The study revealed that older adults, people with lower incomes, and those taking multiple separate pills were most likely to skip their medications. When doctors combined multiple blood pressure drugs into one pill, patients were more likely to take it regularly. These findings suggest that making treatment simpler and more affordable could help more people control their blood pressure and prevent serious health problems.

The Quick Take

  • What they studied: How well people with high blood pressure follow their doctor’s advice about taking medicine and making healthy lifestyle changes, and what factors make it harder for them to stick with treatment.
  • Who participated: 200 adults with high blood pressure in Morocco who visited a clinic between July and October 2022. The study included people of different ages and income levels.
  • Key finding: About 6 out of 10 patients weren’t taking their blood pressure medications regularly. People over 60, those with lower incomes, and those taking multiple separate pills were the least likely to follow their treatment plans.
  • What it means for you: If you have high blood pressure, combining your medications into one pill may make it easier to remember to take them. Cost and access to medications are real barriers that doctors should consider when creating treatment plans.

The Research Details

Researchers conducted a snapshot study of 200 people with high blood pressure at one clinic in Morocco over four months. They asked patients questions about their daily habits, eating patterns, and whether they took their medications as prescribed. To measure medication adherence, they used a standard four-question tool called the Morisky Medication Adherence Scale, which asks about forgetting to take pills, being careless about timing, stopping medication when feeling better, and skipping doses when side effects occur. For lifestyle habits, they used a food frequency questionnaire to assess diet and asked about salt intake and exercise. This approach allowed researchers to gather information about many patients quickly and identify patterns in who struggles most with treatment adherence.

Understanding why people don’t follow their treatment plans is crucial because high blood pressure is a silent condition—people often feel fine even when their blood pressure is dangerously high. If patients don’t take their medications and make healthy changes, they face serious risks like heart attacks and strokes. By identifying which groups struggle most with adherence, doctors can develop better strategies to help patients succeed.

This study provides useful real-world information from actual patients in a clinic setting. However, it was conducted at only one location in Morocco, so the results may not apply equally to all populations worldwide. The study was a snapshot in time rather than following patients over months or years, which limits what we can learn about long-term patterns. The researchers used validated, standard tools to measure adherence, which strengthens the reliability of their findings.

What the Results Show

The study found that medication adherence is a major problem: nearly 6 out of 10 patients (58.3%) were not taking their blood pressure medications as prescribed. This poor adherence was strongly linked to three factors: being older than 60 years, having a lower income, and taking multiple separate pills instead of a combination pill. When patients took a single pill containing multiple blood pressure medications (called fixed-dose combination therapy), they were significantly more likely to take it regularly compared to those taking separate pills. The researchers also found that lifestyle adherence was poor overall, with only about 40% of patients following healthy lifestyle recommendations. However, patients did better with eating fruits and vegetables (about 60% compliance) compared to reducing salt intake (43%) or exercising regularly (only about 25%).

The study revealed that diet was easier for patients to change than exercise habits. More than half of patients successfully ate adequate fruits and vegetables, but very few maintained regular physical activity. This suggests that exercise may face unique barriers such as time constraints, physical limitations, or lack of access to safe places to exercise. The combination of poor medication adherence and poor lifestyle adherence creates a double problem—patients aren’t getting the full benefit of their treatment.

These findings align with what researchers have observed in other countries: medication adherence for chronic conditions like high blood pressure is consistently poor worldwide, typically ranging from 50-70% of patients not taking medications as prescribed. The study confirms that socioeconomic factors (income and access) are universal barriers, not unique to Morocco. The positive effect of combining medications into one pill has been shown in previous research, supporting the idea that simplifying treatment regimens helps patients remember to take their medications.

The study was conducted at only one clinic in Morocco, so results may not represent all Moroccan patients or people in other countries with different healthcare systems. The researchers only collected information at one point in time, so they couldn’t track whether patients’ adherence improved or worsened over time. The study didn’t explore all possible reasons why patients skip medications—factors like side effects, lack of understanding about why treatment is important, or cultural beliefs about medication weren’t fully examined. Additionally, the study relied on patients reporting their own behavior, which may not be completely accurate since people sometimes underreport non-adherence.

The Bottom Line

If you have high blood pressure: (1) Ask your doctor about combining your blood pressure medications into one pill if you’re taking multiple separate pills—this appears to significantly improve adherence. (2) Focus on eating more fruits and vegetables, which seems more achievable than other lifestyle changes. (3) Work with your doctor to find affordable medication options, especially if cost is a barrier. (4) Set reminders on your phone or use a pill organizer to help remember to take medications daily. These recommendations are supported by this research, though individual results may vary.

Anyone with high blood pressure should pay attention to these findings, especially if you’re over 60, have a lower income, or take multiple medications. Healthcare providers should use this information to simplify treatment plans and address cost barriers. People caring for older adults with high blood pressure should help them organize medications and remember to take them. However, this study was conducted in Morocco, so people in very different healthcare systems may experience different barriers.

If you switch to a combination pill or improve your adherence, you may notice better blood pressure control within 2-4 weeks. However, the full benefits of consistent treatment take months to appear. Lifestyle changes like reducing salt and exercising regularly typically show measurable improvements in blood pressure within 4-8 weeks, but require consistent effort.

Want to Apply This Research?

  • Track daily medication adherence with a simple yes/no check-in each evening. Also track weekly salt intake (estimate servings of salty foods) and weekly exercise minutes. Monitor blood pressure readings weekly if you have a home monitor to see the connection between adherence and results.
  • Set a daily medication reminder notification at the same time each day (such as with breakfast or bedtime). Use the app to log when you take your medication and receive encouragement notifications. Create a simple food log to track fruit and vegetable servings and identify easy ways to add more to your diet.
  • Review your adherence data weekly to identify patterns—do you miss doses on certain days? Are there times when you’re more likely to skip medications? Use this information to adjust your routine. Set a monthly goal to gradually increase exercise minutes and reduce salty food servings. Share your adherence data with your doctor at appointments to discuss barriers and solutions.

This research describes patterns observed in one clinic in Morocco and may not apply to all populations or healthcare settings. The findings suggest associations but do not prove cause and effect. If you have high blood pressure, work with your healthcare provider to develop a treatment plan tailored to your individual needs, circumstances, and medical history. Do not change your medications or treatment plan based on this research alone. Always consult your doctor before making changes to your blood pressure management.