IJCS | Volume 33, Nº3, May / June 2020

276 Espeche et al. Adherence to antihypertensive therapy in Argentina Int J Cardiovasc Sci. 2020; 33(3):272-277 Original Article regimen on their own initiative (an act that is inherently willful, not arising from forgetfulness). 2-lapses in implementation (or execution), which is a consequence of forgetfulness or negligence. Therefore, knowing and being able to differentiate between the two types of adherence (persistence or execution) would allow formulating specific strategies aimed to improve one of the main reasons why hypertension is not adequately controlled. 16-22 In our study, the lack of adherence was mostly due to forgetfulness in taking medications or in the time of intake (~ 40% to both). Thus, the use of reminders such as alarms, telemedicine, prescription of fixed combinations and less complex regimens could improve adherence in our population. Our study had some limitations. First, our cross- sectional design precluded the assessment of temporality; rather, we could only obtain associations. Second, adherence was assessed using only one questionnaire – the Morisky scale (only) – which has not been validated to theArgentinean population. However, the instrument had been used in previous studies in our country. 23 The use of a second scale to measure medication adherence would have improved the reliability of our findings. Third, predictors of non-adherence such as a poor patient-provider relationship and time of treatment were not evaluated in this study. Fourth, although this study was carried out in eight cities of different provinces, Argentina is a very large country and a study that covered a greater number of cities, would have greater representation. However, the prevalence of hypertension control was similar to that reported in a previous study conducted in Argentina. 12 Finally, since hypertension control was determined based on BP office values, the possible white coat effect cannot be ruled out. Thus, despite these limitations, our study provides an estimation of non-adherence in an Argentinean cohort. Conclusions In conclusion, adherence rate to antihypertensive drug treatment was higher than the one reported in the literature, but still deficient. The main reason for non-adherence to pharmacological treatment was forgetfulness of medication intake. Therefore, differentiating the two types of adherence (persistence and execution) would allow formulating specific strategies aimed to improve the main reasons why hypertension is not adequately controlled. Finally, the lack of adherence was an important issue in patients with established cardiovascular disease. Author contributions Conception and design of the research: Sabio R, Diaz A. Acquisition of data: Parodi R. Analysis and interpretation of the data: Leiva CES. Statistical analysis: Leiva CES. Writing of the manuscript: Espeche WG, Salazar MR. Critical revision of the manuscript for intellectual content: Grimaldi D, Poppe S, Altube J. In old de conception: Salazar MR and Espeche WG. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Comitefyth under the protocol number EMA1. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study.