Patient adherence and the treatment of hypertension
- Brent M Egan, MD
Brent M Egan, MD
- Professor of Medicine
- University of South Carolina School of Medicine-Greenville
- Chief Science Officer, Care Coordination Institute
- Section Editor
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- Deputy Editors
- Daniel J Sullivan, MD, MPH
Daniel J Sullivan, MD, MPH
- Deputy Editor — Primary Care (Adult)
- Assistant Professor of Medicine
- Harvard Medical School
- John P Forman, MD, MSc
John P Forman, MD, MSc
- Senior Deputy Editor — UpToDate
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
A report using National Health and Nutrition Examination Survey (NHANES) data from 2009 to 2012 found that about 75 percent of hypertensive patients in the United States are being treated, and approximately 70 percent of those being treated have their blood pressure controlled to below 140/90 mmHg (table 1) [1-3]. During this time period, hypertension control among all adults in the United States with hypertension was just over 50 percent. Another study using NHANES data from 2013 to 2014 reported that hypertension was controlled in 54 percent of all hypertensive adults in the United States . (See "The prevalence and control of hypertension in adults".)
Suboptimal adherence with prescribed antihypertensive medication and lifestyle changes contributes to the burden of uncontrolled hypertension [5-7]. This problem persists despite the success that various individual programs have had in attaining high adherence rates with both nondrug  and drug regimens .
This topic will review the major issues related to nonadherence with antihypertensive therapy. A more complete discussion of noncompliance is discussed elsewhere. (See "Compliance with lipid altering medications and recommended lifestyle changes".)
REASON FOR NONADHERENCE
Nonadherence to antihypertensive medication is common. As an example, in a study of 149 hypertensive patients who were monitored with electronic pill boxes, 42 percent were nonadherent, defined as taking less than 80 percent of prescribed antihypertensive medication . In another study, high-performance liquid chromatography-tandem mass spectrometry for drug levels was performed on urine and serum specimens from 1348 hypertensive patients in two countries; partial and complete nonadherence ranged, respectively, from 20 to 27 percent and from 12 to 14 percent . Adherence was lower among patients who were younger, male, and prescribed more than one antihypertensive medication or prescribed diuretics. Other factors have also been found to reduce adherence (table 2).
Suboptimal adherence is a major barrier to realizing the benefits of evidence-based pharmacologic therapies for many medical conditions. Thus, adherence is an important topic of longstanding interest and remains a key barrier to better patient outcomes. Adherence is a complex phenomenon, and no single intervention has solved this challenge.
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- REASON FOR NONADHERENCE
- Patient and disease characteristics
- Treatment characteristics
- ASSESSMENT OF ADHERENCE
- METHODS TO IMPROVE ADHERENCE
- Educate and communicate
- Encourage home blood pressure self-monitoring
- Use technology acceptable to the patient
- Keep treatment inexpensive and simple
- Consolidate refills
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS