Determinants of Suboptimal Adherence to Antihypertensive Therapy Among Adults in Rural Communities in Benue State, North Central Nigeria: An Analytical Study

Hypertension control rates in rural Nigerian communities remain critically low, with medication non-adherence identified as a primary determinant of uncontrolled blood pressure and its complications. Understanding the multilevel determinants of non-adherence in rural settings is essential for designing effective pharmacist-led interventions. This analytical cross-sectional study investigated patient-level, drug-level, and health system-level determinants of suboptimal antihypertensive adherence in rural communities in Benue State, North Central Nigeria. A total of 480 adult hypertensive patients from 16 rural primary health care centres were enrolled using systematic random sampling. Adherence was quantified using the eight-item Morisky Medication Adherence Scale validated in the local context, and blood pressure was measured. Logistic regression analysis was used to identify independent determinants of low adherence. Overall, 58 percent of participants demonstrated low or medium adherence. Multivariate analysis identified rural health facility distance of more than five kilometers, polypharmacy with three or more antihypertensives, absence of pharmacist-initiated patient education, patient belief in herbal alternatives, and monthly drug cost exceeding 10 percent of household income as independent predictors of low adherence. Blood pressure was uncontrolled in 71 percent of low-adherers. The study provides an empirical basis for targeted, multilevel adherence interventions in rural Benue communities, recommending community pharmacist outreach, differentiated drug supply models, and subsidized antihypertensive provision as actionable strategies. Keywords: antihypertensive adherence, rural communities, Benue State, determinants, blood pressure control