Efficacious pharmacologic treatments are available for the management of hypertension, yet only about 50% of patients treated with antihypertensive medications have their blood pressure controlled. A key factor contributing to poor blood pressure control is suboptimal adherence to prescribed therapy. Despite numerous studies conducted over the last 50 years to identify the best method for increasing patient compliance, no single intervention has emerged as superior to the others. This article reviews the effectiveness of methods to improve antihypertensive medication adherence, discusses the effect of drug benefit caps on compliance, and proposes a framework for future clinical and research directions.
Several recent systematic reviews and meta-analyses have attempted to quantify the effectiveness of various methods to improve adherence. As a result of the multiple factors influencing medication adherence, a patient-centered approach that tailors interventions aimed at overcoming barriers to adherence may be necessary.
Physicians and other health care professionals should consider nonadherence to medication when evaluating a patient with poor blood pressure control. In selecting an intervention to improve compliance to medications, clinicians should consider engaging the patient in an intervention that overcomes patient-specific barriers. Future research should target development of adherence models, which simultaneously examine the effects and interactions of social, psychological, and biologic variables on antihypertensive medication adherence.
aDepartment of Clinical Outcomes Research, Ochsner Clinic Foundation, New Orleans, Louisiana; bDepartment of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; and cDepartment of Community Health Sciences, University of California - Los Angeles School of Public Health, Los Angeles, California, USA
Correspondence to Marie A. Krousel-Wood, MD, MSPH, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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