The impact of drug related problems on health-related quality of life among hypertensive patients in Jordan

Keywords: Hypertension, Quality of Life, Medication Errors, Patient Medication Knowledge, Medication Adherence, Risk Factors, Regression Analysis, Cross-Sectional Studies, Jordan


Background: Hypertension is a major cause of cardiovascular diseases with a high prevalence in Jordan. No previous studies have been carried out to determine the effect of the presence of drug-related problems (DRPs) on the health-related quality of life (HRQOL) among hypertensive patients.

Objectives: The purpose of this study was to identify the influence of different types of DRPs on the HRQOL of hypertensive patients.

Methods: A total of 200 hypertensive patients were recruited in this cross-sectional correlation study that was conducted across the cardiac outpatient clinic at Jordan University Hospital. Ethical approval was obtained and patients were recruited using convenience sampling technique. During the study period, patients’ data was used to evaluate their quality of life using RAND-12 scale and to identify DRPs utilizing a systematic evidence based approach.

Results: 200 hypertensive patients (mean age 59.7 years (SD=10.2)) were recruited in this study. Patients showed a poor quality of life on both the physical and mental domains of the RAND-12 scale. The average number of DRPs was 5.1 (SD=2.3). Multiple linear regression analysis showed that among DRPs categories, non-adherence to medications, non-adherence to non-pharmacological therapies and inadequate knowledge about medications were among the main predictors of the poor physical domain of the RAND-12 (Beta= -0.149, -0.226 and -0.230 respectively, p-value < 0.05 for all). On the other hand, only non-adherence to medication and non-adherence to non-pharmacological therapies were significantly associated with poor mental domain of the RAND-12 (Beta= -0.208 and -0.191 respectively, p-value < 0.05 for both).

Conclusion: Prevalence of DRPs among hypertensive patients is a concern that needs attention. These DRPs were associated with poor HRQOL on both the physical and mental domain of the RAND-12 scale. The pharmaceutical care service delivered by pharmacists is needed to identify, prevent and resolve DRPs, which may improve patients HRQOL.


1. Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: a systematic review. J Hypertens. 2004;22(1):11-19.

2. Jaddou HY, Batieha AM, Khader YS, Kanaan AH, El-Khateeb MS, Ajlouni KM. Hypertension prevalence, awareness, treatment and control, and associated factors: results from a national survey, Jordan. Int J Hypertens. 2011;2011:828797. doi: 10.4061/2011/828797

3. Youssef R, Moubarak I, Kamel M. Factors affecting the quality of life of hypertensive patients. East Mediterr Health J. 2005;11(1-2):109-118.

4. Ebrahim S. Clinical and public health perspectives and applications of health-related quality of life measurement. Soc Sci Med. 1995;41(10):1383-1394.

5. Aburuz S, Bulatova N, Twalbeh M, Gazawi M. The validity and reliability of the Arabic version of the EQ-5D: a study from Jordan. Ann Saudi Med. 2009;29(4):304-308.

6. Jakobsson U. Using the 12-item Short Form health survey (SF-12) to measure quality of life among older people. Aging Clin Exp Res. 2007;19(6):457-464.

7. Möller P, Smit R, Petr P, farmakologie NemCB K, Němcové B, Budějovice Č. The SF-36 questionnaire: a tool to assess health-related quality of life. Available at: (accessed 12 Aug 2017).

8. Ware JE Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220-233.

9. Feeny D, Farris K, Côté I, Johnson JA, Tsuyuki RT, Eng K. A cohort study found the RAND-12 and Health Utilities Index Mark 3 demonstrated construct validity in high-risk primary care patients. J Clin Epidemiol. 2005;58(2):138-141. doi: 10.1016/j.jclinepi.2004.08.005

10. Al-Jabi SW, Sa’ed HZ, Sweileh WM, Wildali AH, Saleem HM, Aysa HA, Badwan MA, Awang R. Assessment of health-related quality of life among hypertensive patients: a cross-sectional study from Palestine. J Public Health. 2014;22(3):277-286. doi: 10.1007/s10389-014-0613-z

11. Ha NT, Duy HT, Le NH, Khanal V, Moorin R. Quality of life among people living with hypertension in a rural Vietnam community. BMC Public Health. 2014;14:833. doi: 10.1186/1471-2458-14-833

12. Maheshwari P, Divya M, Shanmugarajan T, Ravichandiran V. A Prospective Study on Health Related Quality of Life among Hypertensive Patients. Res J Pharm Technol. 2015;8(9):1221-1224. doi: 10.5958/0974-360X.2015.00223.1

13. Oza BB, Patel BM, Malhotra SD, Patel VJ. Health related quality of life in hypertensive patients in a tertiary care teaching hospital. J Assoc Physicians India. 2014;62(10):22-29.

14. Shetty SM, Kundapur R, Ganapathy KK, Kiran NU, Kodyalamoole NK, Kempaller VJ. Quality of life and risk factors in hypertensive individuals in the field practice areas of a tertiary-care hospital in coastal Karnataka. Int J Med Sci Public Health. 2016;5(9):1883-1886. doi: 10.5455/ijmsph.2016.300120163

15. Klocek M, Kawecka-Jaszcz K. [Quality of life in patients with essential arterial hypertension. Part II: The effect of clinical factors]. Przegl Lek. 2003;60(2):101-106.

16. Nunes MI. The relationship between quality of life and adherence to treatment. Curr Hypertens Rep. 2001;3(6):462-465.

17. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-543.

18. Munger M. Polypharmacy and combination therapy in the management of hypertension in elderly patients with co-morbid diabetes mellitus. Drugs Aging. 2010;27(11):871-883. doi: 10.2165/11538650-000000000-00000

19. Abu Farha R, Basheti I, Al Ruz HA, Alsaleh A, Aburuz S. Assessment of drug-related problems and their impact on blood pressure control in patients with hypertension. Eur J Hosp Pharm. 2016;23(3):126-130. doi: 10.1136/ejhpharm-2015-000712

20. Malet-Larrea A, Goyenechea E, García-Cárdenas V, Calvo B, Arteche JM, Aranegui P, Zubeldia JJ, Gastelurrutia MA, Martínez-Martínez F, Benrimoj SI. The impact of a medication review with follow‐up service on hospital admissions in aged polypharmacy patients. Br J Clin Pharmacol. 2016;82(3):831-838. doi: 10.1111/bcp.13012

21. Basheti IA, Tadros OK, Aburuz S. Value of a community‐based medication management review service in Jordan: a prospective randomized controlled study. Pharmacotherapy. 2016;36(10):1075-1086. doi: 10.1002/phar.1833

22. Basheti IA, Al-Qudah RA, Obeidat NM, Bulatova NR. Home medication management review in outpatients with chronic diseases in Jordan: a randomized control trial. Int J Clin Pharm. 2016;38(2):404-413. doi: 10.1007/s11096-016-0266-9

23. AbuRuz SM, Bulatova NR, Yousef AM. Validation of a comprehensive classification tool for treatment-related problems. Pharm World Sci. 2006;28(4):222-232. doi: 10.1007/s11096-006-9048-0

24. Hays RD, Morales LS. The RAND-36 measure of health-related quality of life. Ann Med. 2001;33(5):350-357.

25. Al-Shehri A, Taha A, Bahnassy A, Salah M. Health-related quality of life in type 2 diabetic patients. Ann Saudi Med. 2008;28(5):352-360.

26. Aburuz S. The case for evidence-based pharmaceutical care. Res Social Adm Pharm. 2009;11(3): e146–e147. doi: 10.1016/j.sapharm.2009.06.001

27. Pandya N. Facts and comparisons 4.0. J Med Libr Assoc. 2007;95(2):217-219. doi: 10.3163/1536-5050.95.2.217

28. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74.

29. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943-950.

30. Tabachnick BG, Fidell LS. Using Multivariate Statistics (5th Edition). Needham Heights: Allyn & Bacon; 2006. ISBN:0205459382

31. World Medical Association. World medical association declaration of helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-2194. doi: 10.1001/jama.2013.281053

32. Hussein M, Lenjisa J, Woldu M, Tegegne G, Umeta G. Assessment of drug related problems among hypertensive patients on follow up in Adama Hospital Medical College, East Ethiopia. Clinic Pharmacol Biopharmaceut. 2014;3:122. doi: doi:10.4172/2167-065X.1000122

33. Hanus JS, Simões PW, Amboni G, Ceretta LB, Tuon LGB. Association between quality of life and medication adherence in hypertensive individuals. Acta Paulista de Enfermagem. 2015;28(4):381-387. doi: 10.1590/1982-0194201500064

34. Saleem F, Hassali MA, Shafie AA, Atif M, ul Haq N, Aljadhey H. Disease related knowledge and quality of life: a descriptive study focusing on hypertensive population in Pakistan. South Med Rev. 2012;5(1):47-52.
Original Research