The Prevalence of Non-Adherence in Patients with Resistant Hypertension: a Systematic Review and Meta-Analysis

Abstract

Background: Resistant hypertension is quite prevalent and a risk factor for cardiovascular events. Patients with suspected resistant hypertension undergo more screening intensity for secondary hypertension, despite some of them being non-adherent to prescribed pharmacotherapy. The prevalence of non-adherence in this setting varies from about 5 to 80% in the published literature. Apart from the wide range, the relation between method of assessment and prevalence is not well established. Our objective was to establish the overall prevalence of non-adherence in the apparent treatment resistant hypertension population, explore causes of heterogeneity, and evaluate the effect of the method of assessment on the estimate of non-adherence. Methods: We performed a systematic review and meta-analysis. MEDLINE, EMBASE Classic+EMBASE, Cochrane, CINAHL, and Web of Science were searched for relevant articles. Details about the method of adherence assessment were extracted from each included article and grouped into direct and indirect. Pooled analysis was performed using the random effects model and heterogeneity was explored with metaregression and subgroup analyses. Results: The literature search yielded 1428 studies, of which 36 were included. The pooled prevalence of non-adherence was 35% (95% confidence interval 25 to 46 %). For indirect methods of adherence assessment, it was 25% (95% CI 15 to 39 %), whereas for direct methods of assessment, it was 44% (95% CI 32 to 57 %). Metaregression suggested gender, age, and time of publication as potential factors contributing to the heterogeneity. Conclusions: Non-adherence to pharmacotherapy is quite common in resistant hypertension, with the prevalence varying with the methods of assessment.

Rethinking Resistant Hypertension

“…This varied between 25% (95% CI 15 to 39%) using indirect methods of assessment and 44% (95% CI 32 to 57%) using direct methods of assessment. In this study, there was an association between higher prevalence of non-adherence with younger age, gender (higher prevalence of non-adherence in men compared with women), and higher rates of non-adherence were also seen in the more recent studies [ 13 ]. Efforts to diagnose and address non-adherence should be made in all patients with suspected RH.…”

“…Measures to improve medication adherence and the elimination of drugs and substances known to increase BP should be undertaken where possible. Management of medication non-adherence may include interventions such as reminders and pill packs as well as exploration into the reasons underlying non-adherence, which may include specific patient motives and beliefs pertaining to hypertension and its management [ 13 ].…”

Renal Denervation for Uncontrolled Hypertension

“…Large observational studies have shown that roughly half of participants stop taking their antihypertensive drugs within a year for various reasons, including poor patient adherence, adverse effects of drug therapy, and socioeconomic factors. 9 A systematic review (SR) 11 published in 2020 reported that the prevalence of medication nonadherence was 35% in patients with resistant hypertension. Therefore, additional or alternative therapy is required for patients who cannot take medication or do not adhere to their prescribed regimen.…”