Medication Adherence and Associated Factors Among Hypertensive Outpatients in Sana’a City, Yemen: A Cross-Sectional Study

Background Hypertension is the second most prevalent chronic disease in Yemen and a leading contributor to cardiovascular complications. Poor blood pressure control is often linked to low medication adherence, which remains underexplored in the country. Objective This study aimed to assess the level of adherence to prescribed antihypertensive medications and identify demographic, socioeconomic, knowledge, and awareness-related factors associated with adherence among hypertensive outpatients in Sana’a City, Yemen. Materials & Methods A cross-sectional analytical study was conducted among 398 hypertensive outpatients in three major hospitals in Sana’a (two public and one private) between October and December 2023. Data were collected through structured face-to-face interviews using a validated questionnaire, including the Morisky Medication Adherence Scale (MMAS-8) and analyzed with SPSS version 25. Descriptive statistics, bivariate analysis, and multivariate logistic regression were performed to identify independent predictors of medication adherence. Key Results: The overall adherence rate was 12.6% (95% CI: 9.3–15.9%), indicating severely suboptimal adherence. Independent factors significantly associated with non-adherence included younger age (35–44 years: aOR = 0.08, p = 0.004; 45–54 years: aOR = 0.19, p = 0.028), illiteracy (aOR = 0.15, p = 0.023) and university education (aOR = 0.17, p = 0.019), being a housewife (aOR = 0.16, p = 0.047), diabetes comorbidity (aOR = 0.18, p = 0.008), and sedentary lifestyle (aOR = 3.84, p = 0.007). High knowledge of complications demonstrated a protective effect (aOR = 0.36, p = 0.022). Surprisingly, moderate awareness was associated with higher adherence compared with high awareness (aOR = 3.58, p = 0.038). Key Conclusion and Recommendations: Medication adherence among hypertensive patients in Sana’a is alarmingly low, reflecting substantial challenges in chronic disease management within the current health and socioeconomic context. Younger age, educational extremes, diabetes, sedentary lifestyle, and a failure to achieve optimal self-assessment "roles were significant barriers. Multi-faceted strategies addressing behavioral modification, patient education tailored to literacy levels, strengthened counseling and Integrated care pathways services are urgently required to improve adherence and blood pressure control in Yemen.