Medication Adherence Among Hypertensive Patients in Bangladesh: A Nationwide Analysis of Gender and Urban–Rural Disparities

Hypertension remains a major public health concern in Bangladesh, yet comprehensive nationwide studies examining prescription‐based medication adherence are limited. To address this gap and understand adherence patterns for effective hypertension management, this study utilized secondary data from the Bangladesh Demographic and Health Survey (BDHS) 2022. A total of 1597 hypertensive individuals aged 18 years or older (670 urban, 927 rural) were included after excluding cases with missing values. Medication adherence was defined by self‐reported use of prescribed antihypertensive drugs among those identified with hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg or currently taking medication). Univariate, bivariate, and multilevel binary logistic regression analyses were conducted to identify key factors influencing adherence. Findings revealed that 83.2% of participants were adherent to medication. Adherence varied significantly by gender, wealth status, and diabetes comorbidity. In urban males, those from middle and rich households were 90.4% and 86.8% less likely to be adherent than poor counterparts, while nondiabetic men were over four times more likely to be adherent (AOR: 4.459, 95% CI = (1.371, 13.224), p value = 0.013). Among rural females, higher wealth status increased adherence (AOR: 1.998, 95% CI = (1.221, 3.268), p value = 0.006), but those with primary or secondary education showed lower odds of adherence. Urban females from rich households had significantly higher odds of adherence (AOR: 4.759, 95% CI = (1.838, 12.335), p value = 0.002). These findings highlight the substantial gender and urban–rural disparities in hypertension medication adherence in Bangladesh. Targeted policies, such as educational outreach for rural women, expanded diabetes screening in urban men, and subsidized medication access in rural areas, are urgently needed to improve hypertension management.