The results from the present study show a weak or negligible negative correlation between medication adherence and HRQoL. The participants were also reported with decreased HRQoL and poor treatment adherence to medications. Similar results were reported in a meta analysis where hypertension patients were reported with decreased HRQoL [10
]. In another study among hypertensive patients, lower medication adherence was associated with poor HRQoL in a population based survey in Brazil [14
With the exception of the negative association, the current study findings agree with those in the literature [1
]. However, Carbello et al. concluded that certain HRQoL domains are closely related to medication adherence in an HIV population [28
]. These findings were again supported by Takemura and colleagues, who concluded that better adherence is associated with better HRQoL in their study among asthmatic patients in Japan [29
The negative association between medication adherence and HRQoL is explainable using the theoretical model of Self-Regulation [30
]. Interest and involvement of patients in improving one's own health is the key determinant of a successful medical treatment. Medication adherence is an important component of disease state management; however, it is one phase of the entire process. HRQoL, on the other hand, encircles a complex web of psychosocial characteristics that can impact a patients ability to manage their chronic disease and does not depend on a single factor. In the majority of cases, the patient observes their own behaviour and evaluates how this behaviour affects their current health status. Only if the desired results are not realised, a change in personal behaviour is initiated. If the patients are satisfied with the outcomes, they maintain status quo. A weak association from the current study is in line with the recognition that HRQoL is affected by a number of factors and is not limited to medication adherence only.
A possible explanation of this negative association can be attributed to the measurement of medication adherence and HRQoL. Although there is no gold standard for adherence and HRQoL measurement [31
], it is always advisable to use a disease/population specific instrument. This can result in a response to small changes in medication adherence and HRQoL and perhaps can give a stronger association. Even though Cote et al. used four different instruments of HRQoL assessment (RAND-12, SF-12, HUI-2 and HUI-3) and the Morisky Medication Adherence Scale (MMAS) for assessing medication adherence, proposed a disease-specific instrument, which is in line with our suggestions [1
The negative association that was observed here may be linked to the frequency and class of antihypertensive medication used by the patients. The efficacy of antihypertensive agents is unquestionable but certain side effects are always associated with the therapy [33
]. Side effects in adherents can be one possible reason for the decreased HRQoL. Moreover, different antihypertensive agents affect HRQoL in a different way. Even medications from the same pharmacological class, with the same efficacy and safety profile, show different impact on HRQoL [7
]. For example, a study involving two different calcium channel blockers, nifedipine and amlodipine, concluded that nifedipine had a positive effect on overall quality of life compared with no change in the amlodipine group [35
In this context, the duration of the disease itself is very important in interpreting the association between medication adherence and HRQoL. Patients who are recently diagnosed with hypertension may experience an increased HRQoL for the first few months of therapy. However, for chronic hypertensive patients, adherence to medication might not improve HRQoL. Subsequently, HRQoL in chronic patients can be observed as maintained but this preservation is never taken as improved by the patients. This is supported by the current study results, where 146 (37.9%) and 124 (32.3%) of the respondents had hypertension for more than five years and within three to five years, respectively, and reported decreased HRQoL.
The current findings revealed that the study cohort was dominated by age group of 2837years (48.3%) and patients with bachelors level of education (40.0%). However, both treatment adherence and HRQoL are multifactor phenomenon and success or failure of therapy and overall health status are not dependent on a single factor [2
]. Factors such as gender, low socioeconomic status, prescribed drugs, posology, lack of social support, poor patient provider relationship, cost, forgetfulness, and presence of psychological problems should also be kept in mind and evaluated before coming to a conclusion regarding treatment adherence and its effect on HRQoL.