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Received Nov 28, 2017; Revised Apr 11, 2018; Accepted Apr 16, 2018
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1. Introduction
Hypertension is an international public health burden that caused around 9,4 million deaths in 2010 [1]. In Lebanon, hypertension prevalence was 36,9% in adults aged 21 years and above [2]. Reducing sodium intake could significantly lower blood pressure in hypertensive and normotensive patients [3], as well as diminishing the risk of stroke and fatal coronary artery diseases in adults [4]. A wide variety of efficient medications to control hypertension is available [5]. Yet, low rates of controlled hypertension were observed. In USA, 47% of all hypertensive patients and 60% of treated hypertensive patients had controlled blood pressure [6], compared to, respectively, 27% [2] and 48.9% [7] in Lebanon. Patients with uncontrolled blood pressure had a higher risk of nonadherence to their medication [8], while adherent patients had lower systolic blood pressure and diastolic blood pressure [9].
Medication adherence was defined by the WHO as “the extent to which a person’s behavior, taking medication, following a diet, and/or executing lifestyle changes, corresponds to agreed recommendations from a healthcare provider” [10]. In Lebanon, 22.4% of hypertensive patients were nonadherent to their medication [11]. Adherence amelioration was important to reduce hospitalization and mortality due to cardiovascular diseases [12], as well as resulting costs [13]. A precise evaluation of medication adherence and the factors that affect it is needed, with adequate tools to be used in routine clinical practice [14]. The eight-item Morisky Medication Adherence Scale (MMAS-8) is a subjective method, with a 93% sensitivity and a 53% specificity [15]. Even though it is frequently used in studies, as it is simple and not expensive, MMAS-8 does not take patients’ cultural and socioeconomic factors into account, as well as their relationship with their healthcare providers, while these variables affect adherence. In this context, a new scale (Lebanese Medication Adherence Scale: LMAS) was developed, taking into account factors related to the Lebanese culture. It evaluated psychological, occupational, economical, and annoyance factors.
The primary objective of this study was to validate the LMAS in Lebanese hypertensive adults,...