{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:55:36Z","timestamp":1792108536244,"version":"4.4.0"},"reference-count":119,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,5,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Nonadherence to blood pressure (BP)\u2010lowering medication is a strong predictor of poor BP control. Sub\u2010Saharan Africa has extremely low BP control rates (~10%), but it is unclear what the burden of medication nonadherence among Africans with hypertension is. This systematic review estimated the prevalence and determinants of nonadherence to BP\u2010lowering medications in Sub\u2010Saharan Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Multiple databases were searched from inception to December 6, 2023. Two reviewers performed independent screening, extraction, and quality assessment of studies. We pooled the prevalence estimates using random effects meta\u2010analyses and summarized the determinants using a narrative synthesis. From the 1307 records identified, we included 95 studies published between 1995 and 2023. The overall prevalence of nonadherence to BP\u2010lowering medication among 34\u2009102 people treated for hypertension in 27 countries was 43.9% (95% CI, 39.2\u201348.6). There was no change in the prevalence of nonadherence over time. Nonadherence varied by measurement method and by median age (39.4%, \u226557\u2009years versus 47.9%, &lt;57\u2009years). Socioeconomic and patient\u2010related factors were the most frequent factors influencing adherence. Active patient participation in management, accurate perceptions, and knowledge of hypertension and its treatment predicted good medication adherence, whereas high pill burden, medication cost, side effects, and comorbidities predicted poor adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Two out of every 5 people are nonadherent to their BP treatment. With the African population projected to increase from 1.4 to ~2.5 billion by 2050, targeted strategies are urgently needed to optimize medication adherence in people with hypertension in Sub\u2010Saharan Africa.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.037555","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T08:01:55Z","timestamp":1746172915000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["High Burden and Trend in Nonadherence to Blood Pressure\u2010Lowering Medications: Meta\u2010Analysis of Data From Over 34\u2009000\u00a0Adults With Hypertension in Sub\u2010Saharan Africa"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2787-7518","authenticated-orcid":false,"given":"Leopold N.","family":"Aminde","sequence":"first","affiliation":[{"name":"Griffith University","place":["Gold Coast, Australia"]},{"name":"Clinical Research Education, Networking & Consultancy (CRENC)","place":["Douala, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6708-6852","authenticated-orcid":false,"given":"Valirie N.","family":"Agbor","sequence":"additional","affiliation":[{"name":"University of Oxford","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah T.","family":"Fongwen","sequence":"additional","affiliation":[{"name":"Ministry of Public Health","place":["Yaounde, Cameroon"]},{"name":"London School of Hygiene & Tropical Medicine","place":["London, UK"]},{"name":"Diagnostics Access, Africa Centres for Disease Control and Prevention","place":["Addis Ababa, Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calypse A.","family":"Ngwasiri","sequence":"additional","affiliation":[{"name":"Clinical Research Education, Networking & Consultancy (CRENC)","place":["Douala, Cameroon"]},{"name":"Ecole de Sante Publique, Universite Libre de Bruxelles","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2617-6712","authenticated-orcid":false,"given":"Clovis","family":"Nkoke","sequence":"additional","affiliation":[{"name":"University of Buea","place":["Cameroon"]},{"name":"Buea Regional Hospital","place":["Buea, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0208-0211","authenticated-orcid":false,"given":"Miriam A.","family":"Nji","sequence":"additional","affiliation":[{"name":"Northeast Georgia Medical Center","place":["Braselton, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4038-4128","authenticated-orcid":false,"given":"Anastase","family":"Dzudie","sequence":"additional","affiliation":[{"name":"Clinical Research Education, Networking & Consultancy (CRENC)","place":["Douala, Cameroon"]},{"name":"University of Yaounde 1","place":["Yaounde, Cameroon"]},{"name":"Douala General Hospital","place":["Douala, Cameroon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9217-4937","authenticated-orcid":false,"given":"Aletta E.","family":"Schutte","sequence":"additional","affiliation":[{"name":"University of New South Wales","place":["Sydney, Australia"]},{"name":"The George Institute for Global Health","place":["Sydney, Australia"]},{"name":"North\u2010West University","place":["Potchefstroom, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)01330-1"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30752-2"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-021-00559-8"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.114.04394"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/hjh.0000000000001345"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0214934"},{"key":"e_1_3_1_8_2","volume-title":"Adherence to Long\u2010Term Therapies: Evidence for Action","author":"World Health Organization","year":"2003","unstructured":"World Health Organization . 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