How Can We Improve Adherence to Blood Pressure–Lowering Medication in Ambulatory Care?

Abstract

Reducing the number of daily doses appears to be effective in increasing adherence to blood pressure-lowering medication and should be tried as a first-line strategy, although there is so far less evidence of an effect on blood pressure reduction. Some motivational strategies and complex interventions appear promising, but we need more evidence on their effect through carefully designed randomized controlled trials.

Optimizing hypertension management in clinical practice

“…Medication compliance may be further complicated by the largely asymptomatic nature of hypertension. In clinical practice, treatment compliance may be as low as 50%, 74,75 which is much lower than that generally observed in the clinical trial setting where tighter controls and monitoring reduce non-compliance. Furthermore, in addition to issues regarding compliance with antihypertensive therapy, long-term persistence (remaining on therapy) is also problematic.…”

“…minimizing both the number of tablets taken and the frequency of administration); (2) selecting drugs that are well tolerated (as outlined above) and (3) educating and motivating patients to ensure that they adhere to treatment. 74,75,77 Compliance and long-term persistence are linked with tolerability, which therefore adds to the importance of the choice of antihypertensive therapy. 58,75,78,79 Evidence from clinical trials suggests that higher levels of persistence are seen with ARBs than other classes of hypertensive drugs.…”

“…74,75,77 Compliance and long-term persistence are linked with tolerability, which therefore adds to the importance of the choice of antihypertensive therapy. 58,75,78,79 Evidence from clinical trials suggests that higher levels of persistence are seen with ARBs than other classes of hypertensive drugs. 79,80 For example, in a usual-care setting, patients receiving valsartan relative to amlodipine or lisinopril were more compliant and persistent with pharmacologic therapy, independent of patient chronic disease burden.…”

A simplified antihypertensive drug regimen does not ameliorate control of childhood hypertension

“…1 Consequently, long-acting agents that can be given once daily, agents with few adverse effects, and fixed-dose combinations should be preferred. 2 Since there are no studies on the influence of 'modern' drug regimens on blood pressure control in childhood hypertension, we compared blood pressure control in a centre that mostly prescribes rather 'traditional' drugs given more than once per day and in a centre that prescribes almost exclusively antihypertensive drugs (in part as fixed-dose combinations) that can be given once per day.…”

“…1 In addition new antihypertensive drugs that can be given once per day mostly have fewer and less bothersome side effects, and patients taking these drugs often tend to show a greater adherence with the prescribed regimen of care. 1,2 The similar blood pressure control in our patients treated with a 'traditional' drug regimen prescribed more than once per day and in patients treated with new agents that can be given once per day (including fixed-dose combinations) and mostly have fewer side effects appears surprising and deserves three short comments.…”