Volume : 13, Issue : 08, August – 2026
Title:
MEDICATION ADHERENCE AMONG PATIENTS WITH HYPERTENSION IN SAUDI ARABIA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors :
Fatimah Alkhamis, MD, Maryam Mohammed Al Maddy, Naif Ahmed Muhammed Almulhim, MD
Abstract :
Background: Hypertension remains a critical public health challenge in Saudi Arbia, serving as a primary contributor to cardiovascular disease and renal impairment. Despite free national healthcare access, long-term blood pressure control remains suboptimal due to medication non-adherence.
Objective: To pool the overall prevalence of antihypertensive medication adherence among adult patients in Saudi Arabia and quantify key sociodemographic, clinical, and health system-related predictors.
Methods: A systematic search of PubMed, Scopus, Web of Science, Embase, and Saudi Medical Literature was performed for observational studies published up to 2026. Studies utilising validated adherence scales (eg., MMAS-4,MMAS-8,GMAS) were included. Meta-analysis were excluded using random-effects models to calculate pooled proportions and Odds Ratio (OR) with 95% Confidence Intervals (CI).
Results: Across 18 eligible studies (N=6,420 patients), the overall pooled high adherence rate was 38.4% (95% CI: 32.1% – 45.1%; r2 = 94.2%). Moderate adherence was estimated at 34.1% (95% CI: 28.6%-40.1%), while low adherence accounted for 27.5% (95% CI: 22.3% – 33.4%). Major positive predictors of adherence included higher education level (OR=2.37), strong physician communication (OR=2.25), high disease literacy (OR=2.12), and higher household income (OR=2.04). Conversely, polypharmacy ( 3daily medications) was significantly linked with poor adherence (OR = 0.54).
Conclusion: Medication adherence in Saudi hypertensive patients is dangerously low, with under 40% achieving high adherence. Multi-level strategic interventions – including simplified daily pill regimens, digital reminder integration in national health apps, and strengthened patient counselling – are imperative.
Cite This Article:
Please cite this article in press Fatimah Alkhamis et al., Medication adherence among patients with hypertension in Saudi Arabia: A systematic review and meta-analysis.,, Indo Am. J. P. Sci, 2026; 13(08).
REFERENCES:
1. Al-Sowielem, L. S., & Elzubier, A. G. (1998). Compliance and knowledge of hypertensive patients attending primary health care centres in Al-Khobar, Saudi Arabia. Eastern Mediterranean Health Journal, 4(2), 301–307. https://doi.org/10.26719/1998.4.2.301
2. Al-Nozha, M. M., Ali, M. S., & Osman, A. K. (1997). Arterial hypertension in Saudi Arabia. Annals of Saudi Medicine, 17(2), 170–176. https://doi.org/10.5144/0256-4947.1997.170
3. Al-Rukban, M. O., Al-Sughair, A. M., Al-Bader, B. O., & Al-Tolaihi, B. A. (2007). Management of hypertensive patients in primary health care centers in Riyadh, Saudi Arabia. Journal of Family and Community Medicine, 14(1), 17–23.
4. Alsolami, F., Correa-Velez, I., & Hou, X. Y. (2015). Factors affecting antihypertensive medications adherence among hypertensive patients in Saudi Arabia. American Journal of Medicine and Medical Sciences, 5(4), 181–189. https://doi.org/10.5923/j.ajmms.
20150504.07
5. Al-Qazaz, H. K., Sulaiman, S. A., Hassali, M. A., Shafie, A. A., Sundram, S., Al-Haddad, M. S., & Syed Sulaiman, S. A. (2011). Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes. International Journal of Clinical Pharmacy, 33(6), 1028–1035. https://doi.org/10.1007/s11096-011-9582-2
6. Alqarni, A. M., Alrahbeni, T., AlQarni, A., & Alqarni, H. M. (2019). Adherence to antihypertensive medications and its associated factors among hypertensive patients in Saudi Arabia. Saudi Medical Journal, 40(12), 1265–1271. https://doi.org/10.15537/smj. 2019.12.24688
7. Al-Khatheri, A. S., Al-Sanie, A. M., & Al-Malki, A. M. (2021). Barriers to compliance of hypertensive patients in Abha City, Saudi Arabia. Middle East Journal of Family Medicine, 19(12), 24–32. https://doi.org/10.5742/MEJFM.2021.95182
8. Naqvi, A. A., Hassali, M. A., Rizvi, M., Zehra, A., Iffat, W., & Ladak, A. A. (2019). Development and validation of the General Medication Adherence Scale (GMAS) in patients with chronic diseases. Saudi Pharmaceutical Journal, 27(5), 638–646. https:// doi.org/10.1016/j.jsps.2019.03.008
9. Al-Zamakhshary, M., Al-Jahdali, H., & Al-Moamary, M. S. (2022). Medication adherence in chronic disease management within the Saudi healthcare system: A nationwide challenge. Journal of Health Specialties, 10(2), 45–52.
10. Al-Ghurair, S. A., Hughes, C A., Simpson, S. H., & Guirguis, L. M. (2012). A systematic review of patient self-reported barriers to adherence to antihypertensive medications. Research in Social and Administrative Pharmacy, 8(6), 480–513. https://doi.org/10.1016/ j.sapharm.2011.12.003
11. Morisky, D. E., Green, L. W., & Levine, D. M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24(1), 67–74. https://doi.org/10.1097/00005650-198601000-00007
12. World Health Organization. (2003). Adherence to long-term therapies: Evidence for action. World Health Organization. Geneva, Switzerland. ISBN: 9241545992.