Principais fatores relacionados à não adesão ao tratamento medicamentoso da hipertensão arterial na população brasileira: uma revisão integrativa

Abstract

Arterial hypertension represents a significant public health problem in Brazil and worldwide, characterized by its chronicity, multifactorial nature, and high potential to cause cardiovascular and renal complications. Although clinical guidelines recommend the early initiation of pharmacological treatment and demonstrate its effectiveness in blood pressure control, adherence to treatment remains a significant challenge, compromising therapeutic outcomes. This study aimed to analyze the available evidence in the literature regarding the factors associated with non-adherence to medication in the treatment of arterial hypertension among Brazilian adults. The review was conducted in accordance with PRISMA guidelines, with a protocol registered on the Open Science Framework platform. The research question was developed using the PICO strategy. A literature search was carried out in five databases (PubMed, BVS, CINAHL, EMBASE, and Cochrane Library), using controlled descriptors in different languages. Studies published up to May 2025 were included, in Portuguese, English, and Spanish, addressing medication non-adherence among hypertensive Brazilian adults. The analysis considered methodological aspects, level of evidence, and risk of bias, using specific tools according to the type of study. A total of 912 studies were identified, of which 53 met the eligibility criteria. The results were organized into two thematic categories: non-modifiable factors (such as age, sex, education level, and comorbidities) and modifiable factors (such as knowledge about the disease, lifestyle habits, relationship with healthcare professionals, and complexity of the therapeutic regimen). Non-adherence rates ranged from 9.9% to 86.76%, highlighting the multifactorial nature of the phenomenon. Low education level, forgetfulness, absence of symptoms, medication side effects, limited access to medication, and a weakened bond with the healthcare team were recurring factors among the findings. It is concluded that non-adherence to pharmacological treatment for arterial hypertension is a multifactorial and still prevalent issue in Brazil. A broad and contextualized understanding of the associated factors is essential to support more effective intervention strategies, centered on the patient and healthcare services.