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Electronic compliance monitoring in resistant hypertension: the basis for rational therapeutic decisions

Burnier, Michel; Schneider, Marie Paule; Chioléro, Arnaud; Stubi, Claire Lise Fallab; Brunner, Hans R.

Original papers: Therapeutic aspects

Objective Incomplete compliance is one of several possible causes of uncontrolled hypertension. Yet, non-compliance remains largely unrecognized and is falsely interpreted as treatment resistance, because it is difficult to confirm or exclude objectively. The goal of this study was to evaluate the potential benefits of electronic monitoring of drug compliance in the management of patients with resistant hypertension.

Methods Forty-one hypertensive patients resistant to a three-drug regimen (average blood pressure 156/106 ± 23/11 mmHg, mean ± SD) were studied prospectively. They were informed that for the next 2 months, their presently prescribed drugs would be provided in electronic monitors, without any change in treatment, so as to provide the treating physician with a measure of their compliance. Thereafter, patients were offered the possibility of prolonging the monitoring of compliance for another 2 month period, during which treatment was adapted if necessary.

Results Monitoring of compliance alone was associated with a significant improvement of blood pressure at 2 months (145/97 ± 20/15 mmHg, P< 0.01). During monitoring, blood pressure was normalized (systolic < 140 mmHg or diastolic < 90 mmHg) in one-third of the patients and insufficient compliance was unmasked in another 20%. When analysed according to tertiles of compliance, patients with the lowest compliance exhibited significantly higher achieved diastolic blood pressures (P = 0.04). In 30 patients, compliance was monitored up to 4 months and drug therapy was adapted whenever necessary. In these patients, a further significant decrease in blood pressure was obtained (from 150/100 ± 18/15 to 143/94 ± 22/11 mmHg, P = 0.04/0.02).

Conclusions These results suggest that objective monitoring of compliance using electronic devices may be a useful step in the management of patients with refractory hypertension, as it enables physicians to take rational decisions based on reliable and objective data of drug compliance and hence to improve blood pressure control.

Division of Hypertension and Vascular Medicine and Policlinique Médicale Universitaire, Lausanne, Switzerland.

Received 16 June 2000

Revised 10 October 2000

Accepted 10 October 2000

Sponsorship: This work was supported by research grants from Pfizer AG and Bristol-Myers Squibb.

Correspondence and requests for reprints to Professor M. Burnier, Policlinique Médicale Universitaire, Rue César Roux 19, 1005 Lausanne, Switzerland. Tel: 0041 21 345 22 22; fax: 0041 21 345 20 19; email:

© 2001 Lippincott Williams & Wilkins, Inc.