According to Gram Research analysis, about 36% of people with high blood pressure in Somalia don’t take their medications regularly, with a cross-sectional study of 373 patients finding that those with diabetes or eating high-salt diets were significantly less likely to stick with their pills, while those with heart disease were more motivated to take them consistently. The research shows that personalized support addressing individual barriers—like dietary changes or managing multiple health conditions—may improve medication adherence better than generic reminders.
A new study from Somalia looked at why people don’t take their blood pressure medications as prescribed. Researchers surveyed 373 patients and found that about one-third weren’t taking their pills regularly. The study discovered surprising patterns: people with heart disease were more likely to stick with their medications, while those with diabetes or eating too much salt were less likely to take them. The findings suggest that doctors need to understand each patient’s unique situation—including their diet and other health conditions—to help them remember to take their blood pressure pills every day.
Key Statistics
A 2024 cross-sectional study of 373 hypertensive patients in Mogadishu, Somalia found that 36.5% exhibited low adherence to their blood pressure medications, meaning they frequently missed doses or didn’t take their pills as prescribed.
According to research reviewed by Gram, patients with type 2 diabetes were 55% less likely to take their blood pressure medications regularly compared to those without diabetes in a 373-patient study conducted in Somalia.
A 2024 study of 373 hypertensive patients in Somalia found that those with ischemic heart disease were 2.15 times more likely to adhere to their blood pressure medications compared to patients without heart disease, suggesting serious cardiac events increase medication motivation.
Research from a 373-patient cross-sectional study in Somalia showed that high-salt diet consumption was independently associated with 54% lower odds of adhering to blood pressure medications, highlighting the link between dietary habits and medication compliance.
The Quick Take
- What they studied: How many people with high blood pressure actually take their medications as directed, and what factors influence whether they remember to take their pills
- Who participated: 373 adults with high blood pressure who were receiving treatment at a hospital in Mogadishu, Somalia. About 54% were men, and 46% were 65 years old or older. All had been on blood pressure medication for at least six months
- Key finding: About 64% of patients took their blood pressure medications regularly, but 36% didn’t take them as prescribed. People with heart disease were more likely to take their pills, while those with diabetes or eating salty foods were less likely to stick with their medication routine
- What it means for you: If you have high blood pressure, understanding what makes it hard to remember your pills—like having diabetes or eating too much salt—can help you and your doctor create a better plan. This research suggests personalized approaches work better than one-size-fits-all advice
The Research Details
Researchers conducted a cross-sectional study, which is like taking a snapshot of a group of people at one point in time. Between January and April 2024, they recruited 373 patients with high blood pressure from a hospital in Mogadishu who had been taking blood pressure medications for at least six months. They used a simple random sampling method, meaning each eligible patient had an equal chance of being selected, which helps reduce bias.
To measure medication adherence, the researchers used a validated questionnaire called the Morisky Medication Adherence Scale (MMAS-8). This 8-item tool asks patients about their medication-taking habits through questions like whether they ever forget to take their pills or skip doses when they feel better. Patients’ answers were scored, with higher scores indicating better adherence. Scores of 6-8 meant the patient was taking their medication regularly, while scores below 6 indicated poor adherence.
The researchers then used statistical analysis to identify which factors independently predicted whether someone would take their medications regularly. They examined multiple factors including age, sex, marital status, diet, and the presence of other health conditions like diabetes and heart disease.
Understanding medication adherence is crucial because high blood pressure is the leading preventable cause of heart disease and early death worldwide. In Somalia specifically, only about 10% of people with high blood pressure have it under control, which is extremely low. By identifying the specific factors that prevent people from taking their medications, doctors and public health officials can design better interventions tailored to their patients’ real-world challenges
This study has several strengths: it used a validated, well-established measurement tool (MMAS-8) that has been tested in many countries, included a reasonably large sample size (373 patients), and used appropriate statistical methods to identify independent predictors. However, the main limitation is that it relied on patients self-reporting whether they took their medications, which can be inaccurate—people may overstate their adherence. Additionally, this was a snapshot study at one hospital in one city, so the findings may not apply to all people with high blood pressure in Somalia or other countries. The researchers acknowledge these limitations and recommend future studies using objective measures like pill counts or pharmacy records
What the Results Show
Among the 373 patients studied, 63.5% (approximately 237 people) demonstrated high or moderate adherence to their blood pressure medications, meaning they took their pills regularly as prescribed. Conversely, 36.5% (approximately 136 people) exhibited low adherence, indicating they frequently forgot doses or didn’t take their medications consistently.
The study identified four independent factors that significantly influenced medication adherence. Having type 2 diabetes was associated with lower odds of taking blood pressure medications regularly—patients with diabetes were about 55% less likely to be adherent compared to those without diabetes. Similarly, consuming a high-salt diet was independently associated with lower adherence, with patients eating lots of salt being about 54% less likely to take their medications consistently.
Interestingly, having ischemic heart disease (a type of heart disease caused by reduced blood flow) showed the opposite pattern. Patients with heart disease were 2.15 times more likely to take their blood pressure medications regularly compared to those without heart disease. This suggests that experiencing a serious heart condition may motivate people to be more careful about taking their medications.
Marital status also played a role. Divorced patients were about 3 times more likely to adhere to their medication regimen compared to married patients, though the researchers note this finding was based on a smaller number of divorced participants and should be interpreted cautiously.
The study found that age and sex were not independently associated with medication adherence in this population, suggesting that both men and women of various ages face similar challenges with remembering to take their blood pressure pills. The presence of multiple health conditions (comorbidities) appeared to create different motivational dynamics—while diabetes reduced adherence, heart disease increased it, suggesting that the type of comorbidity matters more than simply having additional health problems
This is the first study specifically examining medication adherence among hypertensive patients in Somalia, so it fills an important research gap. The overall adherence rate of 63.5% is comparable to rates reported in other low- and middle-income countries, though somewhat lower than rates in high-income countries where adherence often exceeds 70%. The finding that diabetes is associated with lower adherence aligns with previous research showing that managing multiple chronic conditions can overwhelm patients. However, the strong positive association between heart disease and adherence is noteworthy and suggests that the severity or acuteness of a condition influences motivation differently than chronic disease burden alone
The study’s main limitation is reliance on self-reported medication adherence through questionnaires, which can overestimate actual adherence since patients may report taking medications more consistently than they actually do. The study was conducted at a single hospital in Mogadishu, so results may not represent all people with high blood pressure in Somalia or other countries with different healthcare systems. The cross-sectional design captures only one moment in time, so researchers cannot determine whether the identified factors cause poor adherence or simply occur together. Additionally, the study couldn’t measure objective adherence through methods like pill counts or pharmacy refill records. The researchers also note that the small number of divorced participants limits confidence in that particular finding
The Bottom Line
If you have high blood pressure, work with your doctor to create a personalized medication plan that accounts for your specific situation. If you also have diabetes, you may need extra support or reminders to take your blood pressure pills regularly—consider using pill organizers, phone alarms, or apps to help. Reducing salt intake may also make it easier to stay motivated about taking your medications. If you’re struggling to remember your pills, tell your doctor—they may be able to simplify your medication schedule or suggest other strategies. These recommendations are based on observational research, so individual results may vary
Anyone with high blood pressure should care about these findings, particularly those who also have diabetes or eat a high-salt diet, as they may face extra challenges with medication adherence. Healthcare providers in Somalia and similar settings should use these insights to develop better patient education and support systems. People with heart disease may already be motivated to take their medications, but they should maintain this positive behavior. The findings are most directly applicable to people in low- and middle-income countries with similar healthcare systems, though the general principles about motivation and comorbidity may apply more broadly
Improving medication adherence typically shows benefits within weeks to months. Blood pressure control usually improves within 2-4 weeks of consistent medication use, though it can take several months to reach optimal levels. The longer-term benefits—reduced risk of heart attack and stroke—develop over years of consistent adherence
Frequently Asked Questions
Why do people with diabetes have trouble taking their blood pressure pills?
A 2024 study of 373 patients found that people managing diabetes were 55% less likely to take blood pressure medications regularly. Managing multiple chronic conditions simultaneously can overwhelm patients, making it harder to maintain consistent medication routines despite good intentions.
Does having heart disease help people remember to take blood pressure medication?
Research shows patients with heart disease were 2.15 times more likely to take blood pressure medications consistently. Experiencing a serious cardiac event appears to create strong motivation to follow medical treatment, unlike chronic conditions like diabetes that develop gradually.
What percentage of people actually take their blood pressure pills as prescribed?
A 2024 cross-sectional study of 373 patients in Somalia found that 63.5% took their blood pressure medications regularly, while 36.5% had low adherence. This means more than one-third of patients weren’t taking their pills consistently as directed.
Can eating too much salt affect whether I take my blood pressure medication?
Research from a 373-patient study found that high-salt diet consumption was independently associated with 54% lower odds of medication adherence. The connection suggests dietary habits and medication-taking behaviors may be linked through overall health motivation and lifestyle patterns.
What’s the best way to improve blood pressure medication adherence?
According to a 2024 study of 373 patients, personalized interventions addressing individual barriers—such as managing comorbidities like diabetes, reducing salt intake, and providing targeted support—appear more effective than generic reminders for improving medication adherence.
Want to Apply This Research?
- Log your blood pressure medication intake daily using a simple yes/no checklist. Track this for 4 weeks to establish a baseline, then set a goal to achieve 90% adherence (missing no more than 3 doses per month)
- Set a daily phone alarm at the same time you normally take your medication. Link this habit to an existing routine—for example, take your pill with breakfast or right before brushing your teeth at night. Use the app to record when you take your medication immediately after taking it, while it’s fresh in your mind
- Review your adherence data weekly in the app to identify patterns—do you miss doses on certain days or times? Use this information to adjust your routine. Share your adherence report with your doctor at each visit to discuss any barriers you’re facing and celebrate successes
This research is observational and based on patient self-reports of medication use, which may not reflect actual adherence. The findings come from a single hospital in Somalia and may not apply to all populations or healthcare settings. This information is educational and should not replace professional medical advice. If you have high blood pressure, consult your healthcare provider before making any changes to your medication routine or lifestyle. Always take medications exactly as prescribed by your doctor, even if you feel well.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.