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Patient adherence and the treatment of hypertension

Brent M Egan, MD
Section Editor
George L Bakris, MD
Deputy Editors
Daniel J Sullivan, MD, MPH
John P Forman, MD, MSc


A report using National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2014 that defined hypertension as 130/80 mmHg found that about 55 percent of hypertensive patients in the United States were being treated, and approximately 47 percent of those being treated had their blood pressure controlled to below 130/80 mmHg [1,2]. Using a hypertension threshold of 140/90 rather than 130/80 mmHg, hypertension treatment and control were, respectively, about 75 and 70 percent (table 1) [3-5]. (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 [6-8]. This problem persists despite the success that various individual programs have had in attaining high adherence rates with both nondrug [9] and drug regimens [10].

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".)


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 [11]. 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 [12]. 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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Literature review current through: Nov 2017. | This topic last updated: Nov 21, 2017.
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