To the best of our knowledge, no studies of the determinants of adherence and treatment satisfaction among patients with hypertension in Palestine have been carried out previously. Although limited studies have reported medication adherence among Arab populations suffering from different diseases, there is a lack of data concerning medication adherence and treatment satisfaction solely among hypertensive patients. This is therefore the first attempt to determine the relationship between medication adherence and treatment satisfaction in Palestine and Arab hypertensive patients. An improved understanding of the determinants associated with medication adherence and treatment satisfaction has become an important outcome in management strategies for hypertension [6, 18]. Such understanding will help predicting hypertensive patient’s life and perceptions of illness. Therefore, the aim of this pioneering study in Palestinian health care settings was to assess the relationship between medication adherence and treatment satisfaction in hypertensive patients. Determining patient adherence to antihypertensive medications in outpatient settings is an important first step for physicians and other health care providers in understanding the effectiveness of or satisfaction to the treatments they prescribe, identifying barriers to treatment, and improving blood-pressure control . It is important for health care providers to consider low treatment satisfaction or low medication adherence as a factor contributing to poor blood pressure control to actively engage patients in the selection of strategies to improve adherence [9, 18, 21]. The ability to identify indicators of low medication adherence is crucial for both improving clinical care and determining targets of intervention for the prevention of complications and treatment of hypertension.
A review of the literature revealed that adherence to treatment of hypertension is influenced by a number of factors [3, 22–24]. Medication adherence rates have been shown to be related with age, gender, and race [25, 26]. Other factors are modifiable which reported negatively impact adherence to prescribed medications include depression , lack of knowledge regarding hypertension and its treatment , complexity of medication regimen , side effects of medication , patient satisfaction , and poor quality of life . In our study, we identified one modifiable variable in the multiple regression model that predict medication adherence. Some of the interesting findings in the model indicated that treatment satisfaction was significantly associated with medication adherence. This implies the need for effective communication between the physician or pharmacist and patients to improve understanding regarding hypertension and its treatment.
Treatment satisfaction may be associated with medication adherence for several reasons, including patients’ attitudes or beliefs towards taking antihypertensive medications . Morisky et al.  and Bharmal et al.  stated that the exact mechanism through which treatment satisfaction is associated with medication adherence is unknown; however, low treatment satisfaction appears to be associated with psychosocial well-being which can negatively impact a patient’s ability to manage their chronic illnesses and other health problems. Previous studies performed among hypertensive patients have linked treatment satisfaction to numerous factors, which are recognised to be precursors to medication adherence. These include patients’ beliefs, their perceived level of competence, knowledge and attitudes about disease treatment, and their overall attitude to life [3, 6, 10, 11]. Further research is needed to understand the real mechanisms through which treatment satisfaction is associated with adherence to antihypertensive medications.
Our study is the first one to assess adherence and satisfaction among Arab patients with hypertension using validated tools; however, our study has a few limitations. Firstly, the major limitation of this study is its cross-sectional design, which precludes causal relationships to be identified. Secondly, no account has been made of hypertension severity, therefore, a more accurate measure may be needed to assess whether blood pressure is well controlled or not. Finally, the participants were drawn from one district and therefore, our findings cannot be generalised to the entire country.