Background Hypertension is one of the leading risk factors for mortality and morbidity worldwide. It is a chronic medical condition characterized by blood pressure (BP) consistently elevated above normal. Even though it is a global public health issue, it disproportionately affects populations in low- and middle-income countries that account for nearly 80% of deaths where health systems are weak. Adherence to medication therapy and lifestyle change is an aspect of patients’ care that is often overlooked and should be evaluated as a crucial part of cardiovascular management. Objective To assess the adherence to recommended lifestyle modifications and associated factors among adult hypertensive patients attending chronic follow-up units at hypertension sentinel site health facilities in Bahir Dar City, northwest Ethiopia in 2024. Methods A facility-based cross-sectional study was conducted in hypertension sentinel site health facilities in Bahir Dar city from April 24 to May 23, 2024. A total of 421 hypertensive patients were included in the study using a systematic random sampling technique. Data were collected through Computer-Assisted Personal Interviews (CAPI) and patient reviews using the KoboCollect. Data were analyzed using SPSS. Logistic regression analysis was used to identify factors associated with adherence to lifestyle modifications. Results The study found that 271 (64.4%) of the respondents were adherent to all studied lifestyle practices. Participants with good knowledge about lifestyle modification (AOR = 4.48 (2.30-8.75), good self-efficacy (AOR = 2.84 (1.61-5.01), good adherence to antihypertensive medication (AOR = 4.64 (2.54-8.45), primary education (AOR = 0.40 (0.18-0.89), underweight (AOR = 0.26(0.08-0.87), and overweight/ obese (AOR = 0.07 (0.04 -0.14) were factors associated with adherence to lifestyle modification. Conclusions The study revealed a relatively medium adherence to lifestyle modifications among hypertensive patients. Good knowledge about lifestyle modification, good self-efficacy, and good adherence to antihypertensive medication were the factors positively associated with adherence to lifestyle modification, whereas, Patients with Primary education, underweight, and overweight/ obese were the factors negatively associated. Interventions targeting primary education, and underweight and overweight to raise knowledge status, medication adherence, and good self-efficacy will result in increased adherence.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Bahir Dar University College of Medicine and Health Sciences Institutional Review Board (IRB) approved the protocol on the ethical principles of the Helsinki Declaration and assigned it reference number 886/2023. Amhara national regional state public health institute (APHI) also provided a letter granting permission for the facilities to take part in the study, with letter number 03/2106.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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The data underlying the results presented in the study are available from the corresponding author, Melaku A., upon reasonable request. He can be contacted via email at melaku.abebe28@gmail.com.