Arterial blood pressure is considered within the "normal" range when the systolic pressure falls between 90 and 119 mmHg, and the diastolic pressure falls between 60 and 79 mmHg. A person is considered hypertensive when their arterial pressure is equal to or more than 120/80 mmHg [1-3].

Hypertension, also known as HTN, is a persistent medical condition that is often managed using medications that reduce the amount of blood pumped by the heart. Cardio inhibitors can either block beta-adrenoceptors on the heart (known as beta-blockers) or L-type calcium channels (known as calcium channel blockers). This action leads to a decrease in heart rate and contractility (inotropy). Vasodilator medications, which reduce the resistance in the blood vessels throughout the body, are employed to lower blood pressure. Other drugs, such as alpha-adrenoceptor antagonists (alpha-blockers), direct-acting vasodilators, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers, are also utilised in the treatment of hypertension.

Diabetes is a metabolic condition marked by elevated levels of glucose in the blood and a deficiency or ineffectiveness of insulin. Type I diabetes, also known as insulin shortage, is caused by a reduction in the quantity of beta cells present in the pancreas. Type II diabetes is the predominant form of diabetes, accounting for approximately 90% of all diabetes cases.

Diabetes can be controlled using both medication and non-medication methods. Medication options include sulfonylureas, dipeptidyl peptidase-4 inhibitors, insulin, biguanides, metaglinides, thiazolidinediones, alpha-glucosidase inhibitors, sodium glucose transporters, and glucagon-like peptides. Additionally, making lifestyle changes can also help reduce the impact of the disease [4-6]. drug adherence often pertains to the extent to which patients follow their recommended drug regimen, including taking the prescription as directed (e.g., twice daily) and consistently continuing to take the prescribed medication [7,8]. Medication adherence can be influenced by several factors, including the intricacy of the prescribed drug regimen, the length of time the therapy is needed, and several psychological factors [9]. Therefore, this study aims to evaluate the extent to which patients in metropolitan areas adhere to their medicine and identify the variables that impede them from following their prescribed treatment.

The current study was to evaluate the medication adherence of patients with hypertension (HTN) and diabetes mellitus (DM) in the central India. Additionally, the study aimed to identify the factors contributing to non-adherence.

This study was conducted in the General Medicine department of a Medical College, which is situated in central India, over a period of 12 months. The study included a sample size of 50 cases, who were admitted during the study period and provided informed consent. The purpose of the study was to analyze the outcomes by analyzing medication adherence and non-adherence.

 Data Collection: The study involved gathering the medical records of patients diagnosed with Type 2 Diabetes Mellitus and Hypertension who were admitted to the hospital's General Medicine Ward during the specified period. The patient underwent an interview during which essential demographic information, including name, age, social and family background, as well as past medical and prescription history, was gathered. The patient's medical record was utilized to gather information pertaining to the IP number, laboratory reports, diagnosis, and recommended medications, which were subsequently documented in the data entry form. The patient was subsequently assessed for medication adherence using the Morisky Medication Adherence scale (MMAS) and for quality of life using a relevant questionnaire such as EQ-5D (Euro QOL-5 Dimensions).

Methodology: Step 1: The annexure utilized in the study were translated into the local language (Kannada) and consent was acquired from patients. Step 2: The demographic information of the patient, such as their name, age, sex, and IP number, was gathered. This included data on their diagnosis, prescribed medications, indications, and the route of administration for those medications. Step 3 involves evaluating the extent to which patients with Type 2 Diabetes Mellitus and Hypertension adhere to their medication regimen. This assessment is done using the Morisky Medication Adherence scale (MMAS). Step 4: Evaluate the quality of life using an appropriate questionnaire such as EQ-5D (Euro QOL-5 Dimensions). Step 5: The acquired data was analyzed using appropriate statistical methods with the use of freely available web tools.

The study included individuals who were above 18 years of age and receiving therapy for Type 2 Diabetes Mellitus with Hypertension, both as inpatients and outpatients.

Exclusion criteria: Patients who declined to participate in the study and did not have both hypertension and diabetes were excluded from the study. Data source: The study comprised inpatients and outpatients who are over 18 years old and receiving therapy for Type 2 Diabetes Mellitus with Hypertension. Patients who declined to participate in the study and did not have both hypertension and diabetes were excluded from the study. The sources of data for this study included patient case records, Case Record Form (CRF), and interviews with patients. 2.6 Statistical Analysis: The statistical methods employed include p-value, odds ratio, Chi-square analysis, and freely accessible web software.

The table presents the age-wise distribution of a sample population of 50 individuals. The majority, 32%, fall within the 61-70 age range, followed by 28% in the 51-60 age range. The 41-50 and 31-40 age groups account for 16% and 14% of the sample, respectively. The younger age group of 20-30 years represents only 4%, and the 71-80 age group constitutes 6%. This distribution indicates a higher concentration of individuals in the older age brackets, particularly those between 51 and 70 years old, comprising 60% of the total sample.

Table 1: Age wise distribution

Table 2 examines factors influencing adherence scores among a sample population, categorized into adherence scores of less than 4 and 4 or greater. Age appears significant, with individuals over 50 years having higher adherence (28 out of 33) compared to those 50 years or younger (13 out of 17), as indicated by a significant p-value of 0.013. Gender does not significantly influence adherence, with males and females showing similar distributions (p=0.681). Education level also shows no significant impact, with both ≤10th standard and >10th standard groups having comparable adherence scores (p=0.340). Employment status is significant, as employed individuals show higher adherence (14 out of 16) compared to unemployed individuals (24 out of 34), supported by a significant p-value of 0.034. Chi-square and odds ratio values provide additional context but indicate that age and employment status are the primary significant factors influencing adherence in this sample.

Table 3 explores the relationship between medication adherence and quality of life, measured by the EQ5D scale. It categorizes adherence into two groups: scores less than 4 and scores of 4 or greater. Among those with an EQ5D score below 50, 10 individuals had an adherence score less than 4, while only 4 had a score of 4 or greater. Conversely, in the group with EQ5D scores of 50 or higher, only 1 individual had an adherence score below 4, while 35 had scores of 4 or greater. The chi-square value of 27.6844 and the odds ratio of 105 (95% CI: 20.257-544.235) indicate a strong and statistically significant association between higher medication adherence and better quality of life, with a p-value of less than 0.00001. This suggests that individuals with better medication adherence tend to have a significantly higher quality of life.

Table 3: Relationship between Medication Adherence and Quality of Life:

The demographic and clinical characteristics of our research sample closely resembled those reported in earlier studies on type 2 diabetes with hypertension. A total of 100 individuals were included in this study. The age group with the highest number of enrolled patients, including both males and females, is 51-60 years, with patients (28%). Similarly, the age group of 61-70 years has  patients (32%). This finding is consistent with a study conducted by S. Das et al[10], which also reported that the majority of patients fell within the 61-70 age category, with 17 patients (30.36%). Upon analysing the distribution by gender, it was observed that males were predominant. Our investigation revealed that males were predominantly afflicted, accounting for 66% of the cases, while females accounted for 34%. This finding aligns with the study conducted by Manjeet Kumar et al[11]. Our study included 43 patients who have a low socio-economic position. This factor is identified as one of the primary causes for non-adherence to treatment, which aligns with the findings of the study conducted by Mosiur Rahman et al[12].

A study conducted by Anders Thelin et al.[13 ]demonstrates that farmers have a reduced risk of developing type 2 diabetes due to their high levels of physical activity and better quality meals. This suggests that the lifestyle and work environment of farmers contribute to their overall health and well-being. The majority of patients included in the study had completed primary and high school education. These patients demonstrated a certain level of understanding regarding their disease and medication, which aligns with the findings of a study conducted by Emilie E Agardh et al[14]. According to their report, lower educational levels accounted for 17.2% of the diabetes burden in men and 20.1% in women in Sweden. In order to evaluate the extent to which patients followed their prescribed medication regimen, we employed the Morisky Medication Adherence Scale (MMAS) questionnaire. This questionnaire was utilised in a previous study conducted by Samson Okello et al. [15] to measure medication adherence in individuals with hypertension and type 2 diabetes.In order to evaluate the health-related quality of life (QOL) of patients, we utilised the European Quality of Life Five Dimensions (EQ5D). Our findings revealed that 72% of the patients exhibited a favourable quality of life, while 28% of the patients did not experience any enhancement in their overall quality of life. These results align with a previous study conducted by Abedini MR et al[16].

In conclusion, our study found that 77% of the participants were compliant with their drug regimen, and 72% experienced an improvement in their overall quality of life. Therefore, by adhering more strictly to medicine, there is a noticeable enhancement in the general quality of life. Among the 50 subjects, 23% of the patients participating in the study were discovered to be non-adherent to their prescription drugs, while 28% of the patients did not exhibit any enhancement in their overall quality of life. The reasons for non-adherence were attributed to factors such as low socio-economic level, educational status, and apprehensions of developing a dependency on the drug. The geriatric patients saw limited enhancement in their overall quality of life mostly due to the presence of several comorbidities, physiological changes, and the use of multiple medications (Poly-pharmacy).Therefore, we may deduce that medication adherence has a direct impact on the quality of life of the patients participating in the study. Therefore, by adhering to medication more consistently, there is a noticeable enhancement in the general quality of life.

The study was conducted for a brief period of time and had a small number of participants, which may not have been sufficient for doing in-depth analysis on various subgroups. Therefore, the results of this study should be verified in a larger study. The selection of antihypertensive and antidiabetic medications should be based on their impact on the patient's renal function, which was not taken into account in this study. Additionally, non-pharmacological methods for lowering blood pressure were not evaluated.

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