FIELD OF THE INVENTION
[001] The present invention relates to the field of medical science, and more particularly, the present invention relates to the hospital-based study of awareness and adherence in patients receiving anti-hypertensive drugs.

BACKGROUND FOR THE INVENTION:
[002] The following discussion of the background of the invention is intended to facilitate an understanding of the present invention. However, it should be appreciated that the discussion is not an acknowledgment or admission that any of the material referred to is published, known, or part of the common general knowledge in any jurisdiction as of the priority date of the application. The details provided herein the background if belongs to any publication is taken only as a reference for describing the problems, in general terminologies or principles or both of science and technology in the associated prior art.
[003] Hypertension is an important worldwide public health challenge. It has changed from a trivial cause of death and disability to one of the global burden diseases. The biggest obstacle for inadequate therapeutic control of blood pressure is meagre knowledge, poor attitude, inadequate treatment practices and lack of adherence towards antihypertensive treatment. The present study is planned to assess the awareness of hypertension on various aspects and to evaluate treatment adherence in hypertensive patients.
[004] Hypertension itself is not a disease but is known as a disease of complication, more so because of an increased risk of concomitant cardiovascular and renal complications. During the past century, hypertension has changed from a minor cause of death and disability to one of the global burden diseases. It has now been recognized as a foremost risk factor for cardiovascular morbidity and mortality. As per the recommendations of the 8th joint national committee Hypertension is defined as blood pressure of 150/90 mmHg in adults 60 years and older, or 140/90 mm Hg or higher in adults younger than 60 years.2 Nearly a billion people are affected by hypertension in the year 2000 and this proportion is said to rise by 29% which is 1.56 billion by the next decade.3 Hypertension is earlier commonly observed in economically developed countries but is not very prevalent economically.
[005] As there has now been a shift towards a sedentary lifestyle of people living in developing countries hypertension has become a major public health problem in India, which is in a midst of an epidemiological transition. Hypertension is known as a silent killer as most people do not have any symptoms at all, but if left uncontrolled may affect many organ systems and lead to end organ damage, resulting in substandard quality of life, an increased rate of dependency, and also increased economic burden on the patient. Over the years, although the rates of detection and control of hypertension have improved, uncontrolled hypertension still remains ubiquitous. Hypertension is preventable and treatable it can be managed by non-pharmacological as well as pharmacological approaches, but still Blood pressure is inadequately controlled in most hypertensives. The biggest obstacle for inadequate therapeutic control of blood pressure is a lack of awareness and knowledge about various aspects of hypertension. Half of the patients are non-adherent to their treatment. There is no doubt that adherence is in turn influenced by knowledge, attitude, and self-care practices (KAP).
[006] In light of the foregoing, there is a need for a hospital-based study of awareness and adherence in patients receiving anti-hypertensive drugsthat overcome problems prevalent in the prior art.

OBJECTS OF THE INVENTION:
[007] Some of the objects of the present disclosure, which at least one embodiment herein satisfies, are as follows.
[008] The principal object of the present invention is to overcome the disadvantages of the prior art by providing a hospital-based study of awareness and adherence in patients receiving anti-hypertensive drugs.
[009] An object of the present invention is to provide a hospital-based study of awareness and adherence in patients receiving anti-hypertensive drugs, wherein the study creates a general awareness about drugs in people, doctors, and patients.
[010] Another object of the present invention is to provide a hospital-based study of awareness and adherence in patients receiving anti-hypertensive drugs, wherein the study helps in the analysis of drug effects on patients.
[011] Another object of the present invention is to provide a hospital-based study of awareness and adherence in patients receiving anti-hypertensive drugs, wherein the hospital-based study is useful in the future of medical science.
[012] Another object of the present invention is to provide a hospital-based study of awareness and adherence in patients receiving anti-hypertensive drugs, wherein the hospital-based study helps Physicians to improve the management of hypertension with a better understanding of the barriers that result in non-adherence.
[013] Another object of the present invention is to provide a hospital-based study of awareness and adherence in patients receiving anti-hypertensive drugs, wherein the hospital-based study generates evidence that allows scope for the development of interventional strategies that can create community awareness about hypertension, as awareness is the first step in formulating a preventive program for the disease.
[014] Yet another object of the present invention is to provide a hospital-based study of awareness and adherence in patients receiving anti-hypertensive drugs, wherein the allows doctors and students to explain the review of hypertension drugs.
[015] Other objects and advantages of the present disclosure will be more apparent from the following description, which is not intended to limit the scope of the present disclosure.

SUMMARY OF THE INVENTION:
[016] The present invention relates to a hospital-based study of awareness and adherence in patients receiving anti-hypertensive drugs.
[017] According to one aspect of our invention, A total of 100 hypertensive patients attending the medicine OPD during the study period are included in the study.
[018] In another aspect of the invention, there is a male preponderance with 57% compared to 43% females.
[019] In another aspect of the invention, the age ranged from 40-60 years with the majority of subjects having hypertension for at least 5 years (41%).
[020] In another aspect of the invention, forty-six percent of subjects are illiterate and 68% of people had a history of complications including stroke and renal abnormality seen in maximum patients (46%) followed by retinopathy.
[021] In another aspect of the invention, the majority of the subjects associated high salt intake (99%), alcohol (82%), and being overweight (75%) as risk factors for uncontrolled hypertension.
[022] In another aspect of the invention, the median (IQR) score on knowledge is 6 (5), attitude 5 (1), and practice 10 (4) respectively.

BRIEF DESCRIPTION OF TABLES:
[023] Reference will be made to embodiments of the invention, examples of which may be illustrated in accompanying figures. These figures are intended to be illustrative, not limiting. Although the invention is generally described in the context of these embodiments, it should be understood that it is not intended to limit the scope of the invention to these particular embodiments.
[024] Table 1 shows a table for Morisky’8-item medication adherencequestionnairein accordance with the present invention.

[025] Table 2 shows a table for the Sociodemographic characteristics of the studysubjects (N=100). in accordance with the present invention.

[026] Table 3 shows a table for knowledge, attitude, and practice scores ofhypertensive patients (N=100) in accordance with the present invention.

[027] Table 4 shows a table for the correct response of hypertensive patientstowards knowledge (N=100) in accordance with the present invention.

[028] Table 5 shows a table for the correct response of the hypertensive patient toward attitude (N=100) in accordance with the present invention.

[029] Table 6 shows a table for the response of hypertensive patients toward self-care practices (N=100). in accordance with the present invention.

[030] Table 7 shows a table for the association of Gender on awareness among hypertensive patients (N=100)in accordance with the present invention.

[031] Table 8 shows a table for the association of the level of education on awareness among hypertensive patients (N=100) in accordance with the present invention.

[032] Table 9 shows a table for Morisky8-itemadherence questionnairescore of hypertensive patients (N=100) in accordance with the present invention.

[033] Table 10 shows a table for the association of gender with adherencetowards antihypertensive medication (N=100) in accordance with the present invention.

[034] Table 11 shows a table for the association of the level of education with adherence towards antihypertensive medication (N=100) in accordance with the present invention.

DETAILED DESCRIPTION OF TABLES:
[035] While the present invention is described herein by way of example using embodiments and illustrative tables, those skilled in the art will recognize that the invention is not limited to the embodiments of table or tables described and is not intended to represent the scale of the various components. Further, some components that may form a part of the invention may not be illustrated in certain figures, for ease of illustration, and such omissions do not limit the embodiments outlined in any way. It should be understood that the tables and the detailed description thereto are not intended to limit the invention to the particular form disclosed, but on the contrary, the invention is to cover all modifications, equivalents, and alternatives falling within the scope of the present invention as defined by the appended claim.
[036] As used throughout this description, the word "may" is used in a permissive sense (i.e. meaning having the potential to), rather than the mandatory sense, (i.e. meaning must). Further, the words "a" or "an" means "at least one” and the word “plurality” means “one or more” unless otherwise mentioned. Furthermore, the terminology and phraseology used herein are solely used for descriptive purposes and should not be construed as limiting in scope. Language such as "including," "comprising," "having," "containing," or "involving," and variations thereof, is intended to be broad and encompass the subject matter listed thereafter, equivalents, and additional subject matter not recited, and is not intended to exclude other additives, components, integers, or steps. Likewise, the term "comprising" is considered synonymous with the terms "including" or "containing" for applicable legal purposes. Any discussion of documents acts, materials, devices, articles, and the like are included in the specification solely for the purpose of providing a context for the present invention. It is not suggested or represented that any or all these matters form part of the prior art base or are common general knowledge in the field relevant to the present invention.
[037] In this disclosure, whenever a composition or an element or a group of elements is preceded with the transitional phrase “comprising”, it is understood that we also contemplate the same composition, element, or group of elements with transitional phrases “consisting of”, “consisting”, “selected from the group of consisting of, “including”, or “is” preceding the recitation of the composition, element or group of elements and vice versa.
[038] The present invention is described hereinafter by various embodiments with reference to the accompanying drawing, wherein reference numerals used in the accompanying drawing correspond to the like elements throughout the description. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiment set forth herein. Rather, the embodiment is provided so that this disclosure will be thorough and complete and will fully convey the scope of the invention to those skilled in the art. In the following detailed description, numeric values and ranges are provided for various aspects of the implementations described. These values and ranges are to be treated as examples only and are not intended to limit the scope of the claims. In addition, several materials are identified as suitable for various facets of the implementations. These materials are to be treated as exemplary and are not intended to limit the scope of the invention.
[039] The present invention relates to a hospital-based study of awareness and adherence in patients receiving anti-hypertensive drugs.
[040] This cross-sectional study is conducted by the department of Pharmacology in collaboration with the department of medicine, HIMS, Dehradun over a period of 6 months after clearance is granted by the institutional ethics committee. A total of 100 patients attending the medicine OPD more than 18yrs of age of both genders, with and without comorbid conditions are included after taking prior informed consent. Pregnant and lactating women are not included in the study. A simple and validated questionnaire form consisting of 27 questions is used which is divided into 3 parts with questions on knowledge, attitude, and practice. The questionnaire is administered to the subjects after being properly explained by the principal investigator and enough time is given to all subjects to understand and answer the questions. Adherence to anti-hypertensive medication is assessed by using The Morisky 8-item medication adherence questionnaire (Table 1).
[041] In addition to this, the sociodemographic history is also recorded. Awareness is assessed according to scores given on all 3 parameters. Knowledge and attitude are scored one for right and zero for wrong answers. Patients frequently following self-care practices are given a score of 2, patients who are moderately following these practices are scored 1, and zero is given to patients.
[042] This cross-sectional study is conducted by the department of Pharmacology in collaboration with the department of medicine, HIMS, Dehradun over a period of 6 months after clearance is granted by the institutional ethics committee. A total of 100 patients attending the medicine OPD more than 18yrs of age of both genders, with and without comorbid conditions are included after taking prior informed consent. Pregnant and lactating women are not included in the study. A simple and validated questionnaire form consisting of 27 questions is used which is divided into 3 parts with questions on knowledge, attitude, and practice.
[043] The questionnaire is administered to the subjects after being properly explained by the principal investigator and enough time is given to all subjects to understand and answer the questions. Adherence to anti-hypertensive medication is assessed by using The Morisky8-item medication adherence questionnaire (Table 1).
[044] The statistical analysis is based on standard descriptive statistical tests using the SPSS software (version 20) and presented in the form of tables and graphs. The association of demographic characteristics of the patients with awareness and adherence is done using the chi-square test and the Mann-Whitney U test the p-value of <0.05 is considered statistically significant.
[045] A total of 100 hypertensive patients attending the medicine OPD during the study period are included in the study. There is a male preponderance with 57% compared to 43% females. The age ranged from 40-60 years with the majority of subjects having hypertension for at least 5 years (41%). Forty-six percent of subjects are illiterate and 68% of people had a history of complications including stroke and renal abnormality seen in a maximum number of patients (46%) followed by retinopathy (Table 2). Majority of the subjects associated high salt intake (99%), alcohol (82%), and being overweight (75%) as risk factors for uncontrolled hypertension (Table 3). The median Most of the subjects gave correct responses on the attitude scale where it is evident that people realize the need for reducing salt intake in their diet (97%), regularly checking blood pressure (86%), and exercising for a healthy life (97%) (Table 5).
[046] It is the scores of self-care practice that are in contrast to the other two parameters and showed that the subjects had poor self-care practices which in turn can be a cause of their uncontrolled blood pressure. Even though having knowledge about high salt intake, increased body weight, able and lack of physical activity being risk factors for hypertension most of the subjects only occasionally moderated their salt intake (75%) and merely 29% of subjects performed physical activity, fewer than that checked their body weight (4%). Most of the subjects occasionally missed their medication (46%) (Table 6). An association between sociodemographic categories and the KAP scores is also drawn out and it is interestingly noted that the association between gender and practice is statistically significant (p<0.05). Males had poor practice as compared to the female subjects (Table 7).
[047] The educational status is also found to be associated with all parameters and this association is highly statistically significant (p<0.05) (Table 8). Out of the total patients, only 40% of people had a Morisky score of less than 1 and are hence adherent the remaining are non-adherent to their medication (Table 9). The association between adherence and gender is significant (p<0.05) and showed females as being more Also, the association between the level of education and adherence is highly significant and illustrated mostly the illiterate to be non-adherent to their anti-hypertensive medication (Table 11).
[048] This Knowledge attitude and practice study is aimed to assess the awareness of hypertension among patients as well as their adherence to anti-hypertensive medication. In the following cross-sectional study, the subjects are of a mean age of 54.33±12.55 similar mean ages are seen in studies conducted by Rahman et al, Bokkampally et al, and Rashidi et al.8-10 This showed that hypertension is previously assumed to be a disease of the elderly is not true anymore and its prevalence is seen more in the middle age group. There is a predominance of female subjects over males which is in contract to most studies that showed a male predominance. Most of the subjects in the study are illiterate, in studies conducted by Olivera et al, Ahmad et al in Jaipur, and Bokkampally et al, in Telangana, the prevalence of hypertension is reported in the illiterate groups or those belonging to low socio-economic backgrounds.
[049] According to the results obtained in this study, most of the subjects had low median scores on knowledge this result is in contrast to that obtained by Sadeq et al, Bokkampally et al, Bhatia et al, Rahman et al, and Shrestha et. al, in which subjects had a good score on the knowledge parameter. Also, in our study there is no association drawn between what is drawn and knowledge which contradicted the study by Sadeq et al, which stated males had better knowledge as compared to females. The present study shows a significant relationship between the level of education and knowledge where most of the graduates had better scores as compared to the illiterate but this is in contrast to a study conducted by Rahman et al, in which no association is found between knowledge scores and level of education.8 Majority of the subjects had a positive attitude towards reducing salt intake in diet, regularly checking blood pressure, and indulging in physical activity to keep their blood pressure under control. This is in accordance with the results obtained by a large number of studies conducted in India as well as in Nepal, Bangladesh, and Iran.6,8,10 Even though the subjects had high median scores on attitude, the scores on knowledge are very poor, which is the main cause of poor self-care practices. Poor scores on self-care practice corresponded with most of the studies except a study by Rashidi et al, in which subjects had good practice scores on lowering salt intake in their diet as well as reduced consumption of fatty food.10 Practice scores are found to be better in females as compared to men which is a novel finding and contrasted with the study by Rashidi et al, who found no association between gender and self-care practice scores. In the current study only 40% subjects showed adheofrence to anti-hypertensive medication this might be attributed to the poor self-care practices that the patient had. Even after showing a positive attitude against all risk factors of hypertension only a small number of people applied these in their daily routine. This is because hypertension is mostly asymptomatic and hypertensives fail to recognize its dreadful complications like coronary artery disease, stroke, and chronic kidney disease, and often become non-complaint with their medication either due to high costs of daily medication, adverse drug reactions that the subjects are not aware of because of inadequate knowledge imparted to them by the physician, religious and cultural believes or lacking access to medical facilities. Poor adherence showed by the subjects in the study is associated with gender where males are mostly non-adherent as compared to females and the level of education where the illiterate are the most non-adherent group amongst all. The results obtained in this study are completely different from the study by Sadeq et al, in which most of the subjects are adherent to their medication and thisresult obtained is not associated with gender or the level of education of the patient. The present invention provides the advantage of providing a hospital-based study of awareness and adherence in patients receiving anti-hypertensive drugs.
[050] The disclosure has been described with reference to the accompanying embodiments herein and the various features and advantageous details thereof are explained with reference to the non-limiting embodiments in the following description. Descriptions of well-known components and processing techniques are omitted so as to not unnecessarily obscure the embodiments herein.
[051] The foregoing description of the specific embodiments so fully revealed the general nature of the embodiments herein that others can, by applying current knowledge, readily modify and/or adapt for various applications such specific embodiments without departing from the generic concept, and, therefore, such adaptations and modifications should and are intended to be comprehended within the meaning and range of equivalents of the disclosed embodiments. It is to be understood that the phraseology or terminology employed herein is for the purpose of description and not of limitation. Therefore, while the embodiments herein have been described in terms of preferred embodiments, those skilled in the art will recognize that the embodiments herein can be practiced with modification within the scope of the embodiments as described herein.

We Claim:

1) A hospital-based study of awareness and adherence in patients receiving anti-hypertensive drugs, the hospital-based studyis conducted ona total of 100 hypertensive patients attending the medicine OPD;
wherein there is a male preponderance of 57% compared to 43% females; and
wherein the age ranged from 40-60 years with the majority of subjects having hypertension for at least 5 years (41%).
2) The hospital-based study as claimed in claim 1, wherein forty-six percent of subjects are illiterate and 68% of people have a history of complications including stroke and renal abnormality seen in maximum patients (46%) followed by retinopathy.
3) The hospital-based study as claimed in claim 1, wherein the majority of the subjects associated high salt intake (99%), alcohol (82%), and being overweight (75%) as risk factors for uncontrolled hypertension.
4) The hospital-based study as claimed in claim 1, wherein the median (IQR) score on knowledge is 6 (5), attitude 5 (1), and practice 10 (4) respectively.