ASH Position Paper: Adherence and Persistence With Taking Medication to Control High Blood Pressure

Abstract

J Clin Hypertens (Greenwich). 2010;12:757‐764. © 2010 Wiley Periodicals, Inc. Nonadherence and poor or no persistence in taking antihypertensive medications results in uncontrolled high blood pressure, poor clinical outcomes, and preventable health care costs. Factors associated with nonadherence are multilevel and relate not only to the patient, but also to the provider, health care system, health care organization, and community. National guideline committees have called for more aggressive approaches to implement strategies known to improve adherence and technologies known to enable changes at the systems level, including improved communication among providers and patients. Improvements in adherence and persistence are likely to be achieved by supporting patient self‐management, a team approach to patient care, technology‐supported office practice systems, better methods to measure adherence, and less clinical inertia. Integrating high blood pressure control into health care policies that emphasize and improve prevention and management of chronic illness remains a challenge. Four strategies are proposed: focusing on clinical outcomes; empowering informed, activated patients; developing prepared proactive practice teams; and advocating for health care policy reform. With hypertension remaining the most common reason for office visits, the time is now.

Hypertension Control Cascade: A Framework to Improve Hypertension Awareness, Treatment, and Control

“…There are several common reasons for therapeutic ineffectiveness in these groups that might be remedied by changing improvement targets 40. For instance, failure to change or increase therapy for patients who are not at goal (“therapeutic inertia”)41, 42 can be addressed by leveraging EHRs to implement treatment algorithms and protocols,16, 28, 38 utilizing clinical decision support tools embedded within EHRs including a 2‐week follow‐up process and patient reminders,19 and changes in team care 43, 44, 45, 46. Treatment‐resistant hypertension is related to age, patient factors, and medical causes of secondary hypertension47 and can be explored by implementing streamlined referral pathways35 and pushing EHR alerts to providers when the BP is elevated 30…”

Simulating Strategies for Improving Control of Hypertension Among Patients with Usual Source of Care in the United States: The Blood Pressure Control Model

“…Medication adherence is comprised of Bexecution^1 9 (taking 100 % of medication doses as prescribed) and Bpersistence^(ongoing use of the medication). 19 Based on an analysis of 21 phase IV clinical trials of antihypertensive medications, 20 we assumed a 50 % persistence at 1 year in the base case. We assumed that imperfect execution (i.e., missed doses) is captured in the average treatment intensification effect and did not separately model this parameter.…”

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

“…6, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32 Reflecting this perspective, a multilevel approach to medication nonadherence is novel,15, 33 as multilevel medication nonadherence factors have received little attention in transplantation 6, 11, 13, 14, 34. Should this new perspective reveal independent multilevel immunosuppressant nonadherence correlates, addressing such correlates would demand interventional approaches targeting not only patients but healthcare workers/family, organizations, and policymakers 6, 21, 24…”