Purpose: To evaluate antihypertensive therapy adherence and to validate the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBCTS) for implementation in Romanian cardiology outpatient practice. Patients and Methods: In this cross-sectional pilot study, 144 adult hypertensive patients completed a Romanian-translated, culturally adapted HBCTS. Mean arterial pressure (MAP) served as an indicator of blood pressure control. Receiver operating characteristic (ROC) analysis determined the optimal adherence cut-off, and multivariable modelling assessed the relationship between HBCTS scores and MAP, adjusting for potential confounders. This study was conducted at an outpatient cardiology clinic in Targu Mureș, Romania, Patients inclusion criteria: adult patients (≥ 18 years) with diagnosed primary hypertension receiving at least one year of continuous antihypertensive therapy, and exclusion criteria: cognitive/communication barriers and secondary hypertension. Results: The HBCTS demonstrated acceptable internal consistency (McDonald’s ω = 0.75; Cronbach’s α = 0.70) and retained a three-factor structure. ROC analysis identified 50 points as the optimal adherence threshold (AUC = 0.81; sensitivity = 0.83; specificity = 0.57). After adjustment, 52.1% of participants met the adherence criterion. Each one-point increase in HBCTS score corresponded to a 35% increase in the odds of achieving controlled blood pressure (OR = 1.35; 95% CI: 1.19– 1.53; p < 0.001). Older age was associated with lower probability of adherence (OR = 0.94; 95% CI: 0.89– 0.98, p = 0.006), whereas permanent employment status increased the chance of higher adherence (OR = 3.36; 95% CI: 1.57– 7.22, p = 0.002). Patients overreported their adherence by 18.5% compared with MAP-defined blood pressure control. Conclusion: These findings support the applicability of the HBCTS in Romanian cardiology outpatient settings and identify key demographic factors associated with patient’s adherence. The validated scale offers cardiology practitioners a reliable instrument to detect adherence barriers among high-risk patients, thereby supporting the implementation of targeted, patient-centered interventions.

Background: Age-related vascular stiffening increases cardiovascular risk by altering ventricular–arterial coupling (VAC). Physical activity, a modifiable factor, may improve cardiovascular health. This pilot study evaluated the relationship between physical activity evaluation and VAC, measured by the carotid–femoral pulse wave velocity to global longitudinal strain (cfPWV/GLS) ratio, in a Romanian primary care cohort. Methods: The prospective cohort analysis was performed on 81 adults (49 females, mean age 50.27 ± 12.93 years). Physical activity was quantified through anamnesis using metabolic equivalents (METs) according with Compendium of Physical Activities, and patients were stratified into four groups: G1 (METs < 1.5, n = 39), G2 (METs = 1.5–2.9, n = 2), G3 (METs = 3–5.9, n = 23), and G4 (METs ≥ 6, n = 17). Demographic and echocardiographic data were recorded to explore associations between physical activity and VAC. Results: The cfPWV/GLS ratio differed significantly across groups (p = 0.012), with the lowest values present in the moderate-intensity group (G3). VAC ≥ 0.391 can predict sedentary lifestyles (AUC = 0.730; CI: 0.617–0.833, p > 0.001). Multivariate analysis revealed that age, arterial age, and hypertension independently predict VAC. Conclusions: Higher physical activity is inversely associated with VAC (cfPWV/GLS ratio) and can predict sedentary lifestyles. Encouraging moderate-to-vigorous exercise in primary care may improve cardiovascular function and aid prevention.