***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Background Adherence to prescribed medication is an imperative issue which can be directly linked with the management of chronic diseases like hypertension ; failure to adhere can affect the effectiveness of medication as well as the efficiency of the health care system . There is scarcity of information regarding the level of drug adherence for antihypertensive medications and its determinants in Ethiopia , particularly in the study area . Therefore , the aim of this study was to assess adherence level and its determinants for antihypertensive medications among adult hypertensive patients attending the chronic illness clinics of the referral hospitals in northwest Ethiopia . Methods Institution based cross sectional study was conducted from March to April , 2016 . The systematic r and om sampling technique was used to select 409 study participants from three referral hospitals . The question naire was prepared using the World Health Organization ( WHO ) conceptual model and by review ing international literature . The data were collected using an interviewer administered question naire . The data were entered in to Epi - Info version 7 and then transferred to the statistical package for social science ( SPSS ) version 20 for data cleaning and analysis .Bivariate analysis was first done to see the association between each independent variables and dependent variable . Variables with a P-value of less than 0.2 in the bivariate analysis were entered in to the multivariate logistic regression model for final analysis . Multivariate analysis was done using Backward logistic regression method . P-value less than 0.05 was considered to determine the statistical significance of the association and odds ratio with a 95 % confidence interval was used to determine the presence , strength , and direction of association between covariates ( explanatory variables ) and the outcome variable . The Morisky medication adherence scale was used to assess the adherence status using > = 6 as adherent or < 6 as non adherent score . Results Four hundred and nine ( 409 ) study participants were interviewed with a response rate of 100 % . The mean age of the respondents was 54.5 years with ( St and ard Deviation ( SD ) ± 13.58 ) . The overall rate of good adherence was 67.2 % ( 95 % CI = 62.8 , 71.6 ) . Participants who had a favourable attitude towards antihypertensive medications ( Adjusted odds ratio ( AOR ) = 9.88 , 95 % confidence interval ( CI ) : 5.34 , 18.27 ) , having good patient- provider relationship ( AOR = 4.25 , 95 % CI : 2.32 , 7.86 ) , having one ( AOR = 4.36 , 95 % CI : 1.34 , 14.12 ) or no ( AOR = 3.38 , 95 % CI:1.01,11.31 ) co-morbidities , a long duration of treatment ( AOR = 1.89 , 95%CI : 1.07 , 3.35 ) , and a low medical cost ( AOR = 2.06 , 95 % CI : 1.13 , 3.76 ) had associations with good drug adherence for antihypertensive medication/s . Conclusions The prevalence of good drug adherence for anti-hypertensive medications in this study was high . Prevention of co- morbidities , making medical services accessible , and maintaining good client-provider interaction are of paramount importance for good drug adherence Background : Adherence to hypertension management in patients with hypertension is known to influence their blood pressure control . It is important to measure patients ’ adherence behaviours to assist with design ing appropriate interventions to improve blood pressure control . Aims : The purpose s of this study were to use confirmatory factor analysis to revali date the Therapeutic Adherence Scale for Hypertensive Patients ( TASHP ) , and to calculate the cut-off score for classifying adherence behaviours into two groups : satisfactory and low adherence behaviours . Methods : Systematic r and om sampling was used to recruit patients with hypertension in China . Demographic characteristics , the TASHP and blood pressure were collected . The psychometric tests of the TASHP included : construct validity , criteria -related validity , internal reliability , and split-half reliability . The area under the receiver operating characteristics curve and Youden index were used to identify the cut-off score of the TASHP for blood pressure control . Results : This study involved 366 patients . Confirmatory factor analysis supported the four-component structure of the TASHP proposed in the original scale development study . The TASHP has a satisfactory internal reliability ( Cronbach ’s α > 0.7 ) and a satisfactory split-half reliability ( Spearman – Brown coefficients > 0.7 ) . The patients with overall scores of the TASHP ⩾ 109 points were considered to have satisfactory adherence behaviours . Conclusion : The TASHP is a vali date d and reliable instrument to measure the adherence to hypertension management in Chinese patients with hypertension . The cut-off score of 109 points can be considered as an effective measure to classify the level of adherence into satisfactory and low adherence behaviours Background The Morisky Medication Adherence scale ( MMAS-8 ) is a widely used self-reported measure of adherence to antihypertensive medications that has not been vali date d in hypertensive patients in sub-Saharan Africa . Methods We carried out a cross-sectional study to examine psychometric properties of a translated MMAS-8 ( MMAS-U ) in a tertiary care hypertension clinic in Ug and a. We administered the MMAS-U  to consecutively selected hypertensive adults and used principal factor analysis and Cronbach ’s alpha to determine its validity and internal consistency respectively . Then we r and omly selected one-sixth of participants for a 2-week test-retest telephone interview . Lastly , we used ordinal logistic regression modeling to explore factors associated with levels of medication adherence . Results Of the 329 participants , 228 ( 69 % ) were females , median age of 55 years [ Interquartile range ( IQR ) ( 46–66 ) ] , and median duration of hypertension of 4 years [ IQR ( 2–8 ) ] . The adherence levels were low ( MMAS-U score ≤ 5 ) in 85 % , moderate ( MMAS-U score 6–7 ) in 12 % and high ( MMAS-U score ≥8 ) in 3 % . The factor analysis of construct validity was good ( overall Kaiser ’s measure of sampling adequacy for residuals of 0.72 ) and identified unidimensionality of MMAS-U. The internal consistency of MMAS-U was moderate ( Cronbach α = 0.65 ) , and test-retest reliability was low ( weighted kappa = 0.36 ; 95 % CI -0.01 , 0.73 ) . Age of 40 years or greater was associated with low medication adherence ( p = 0.02 ) whereas a family member buying medication for participants ( p = 0.02 ) and purchasing medication from a private clinic ( p = 0.02 ) were associated with high adherence . Conclusion The Ug and an version of the MMAS-8 ( MMAS-U ) is a valid and reliable measure of adherence to antihypertensive medication among Ug and an out patients receiving care at a public tertiary facility . Though the limited supply of medication affected adherence , this easy to use tool can be adapted to assess medication adherence among adults with hypertension in Ug and Background Medication adherence is an important predictor of optimal blood pressure control ; hence , it significantly reduces the risk of cardiovascular disease ( CVD ) and associated deaths . However , studies on medication adherence and its associated factors are scarce . Thus , this study aim ed to assess adherence to antihypertensive medications and identify associated factors at Debre Tabor General Hospital , northwest Ethiopia . Methods A hospital-based cross-sectional study was conducted . Simple r and om sampling technique was used to select 346 participants . A structured question naire adapted from the World Health Organization ( WHO ) STEPwise approach was used to collect data . Medication adherence was measured by the four-item Morisky – Green – Levine Scale , with a score ≥3 defined as “ good adherence ” . Data were entered using Epi Info version 7 and exported to SPSS version 20 for analysis . Descriptive and summary statistics were used . Bivariate and multivariable analyses were also carried out . Results A total of 337 hypertensive patients participated in the study . Three-quarters ( 75.1 % ) of the participants were found to be adherent to their medication therapy . The multivariable logistic regression analysis showed that urban residence ( adjusted odd ratio [AOR]=2.10 , 95 % confidence interval [ CI ] : 1.15 , 3.85 ) , taking less than two drugs per day ( AOR=3.04 , 95 % CI : 1.53 , 6.06 ) , and having knowledge about hypertension ( HTN ) and its treatment ( AOR=8.86 , 95 % CI : 4.67 , 16.82 ) were positively and significantly associated with medication adherence , while age > 60 years ( AOR=0.33 , 95 % CI : 0.11 , 0.98 ) was negatively and significantly associated with good medication adherence . Conclusion A significant proportion of hypertensive patients poorly adhere to antihypertensive medications . Age , residence , pill burden , and knowledge about HTN and its treatment are important predictors of medication adherence . Attention should be given to increase the knowledge of patients about their disease and its treatment , and due emphasis should also be given to older and rural patients Confirmation of medication adherence is a challenge in clinical practice and essential for the accurate diagnosis of resistant hypertension . Although it is well established that drug adherence is critical for controlling blood pressure , there are still difficulties applying a simple , inexpensive , and reliable assessment of adherence in the clinical setting . We aim ed to test a simple method to assess adherence in resistant hypertensive ( RH ) patients . A pilot study with normotensives or mild/moderate hypertensive subjects was performed to provide a fluorescence cutoff point for adherence . After that , 21 patients referred to the Resistant Hypertension Clinic had triamterene prescribed and were monitored for a 30-day period . We conducted two unannounced r and omly selected home visits for urine collection to test drug intake that day . Office , home and 24-hour ambulatory blood pressure , biochemical data , and the 8-item Morisky Medication Adherence Scale ( MMAS-8 ) were systematic ally acquired . According to adherence indicated by urine fluorescence , subjects were divided into adherent and nonadherent groups . We found 57 % of nonadherence . No differences were found between groups regarding baseline characteristics or prescribed medications ; Kappa 's test showed concordance between adherence through MMAS-8 items and fluorescence ( kappa = 0.61 ; 95 % confidence interval : 0.28 - 0.94 ; P = .005 ) . Nonadherent patients had higher office ( 81 ± 11 vs. 73 ± 6 mm Hg , P = .03 ) , 24-hour ambulatory blood pressure monitoring ( 75 ± 9 vs. 66 ± 7 mm Hg , P = .01 ) , and home blood pressure measurement ( 77 ± 9 vs. 67 ± 8 mm Hg , P = .01 ) diastolic blood pressure than their counterparts . Nonadherence to antihypertensive therapy is high in patients with RH , even when assessed in clinics specialized in this condition . Fluorometry to detect a drug in the urine of RH patients is safe , easy , and reliable method to assess adherence 
    Output:
    
Conclusion : Medication adherence in the oldest old hypertensive patients seems to be higher than in younger persons .
Adherence in older persons was associated with age , socioeconomic status , and therapy-related factors