Top Things to Know: Medication Adherence and Blood Pressure Control

Published: October 07, 2021

  1. Hypertension is a major risk factor for stroke, heart disease and kidney disease. Over 55 million Americans are currently treated with antihypertensive drugs.
  2. Despite widespread treatment of hypertension resulting in a decline in heart disease and stroke, blood pressure (BP) control rates are not at optimum levels; medication adherence is a chief contributing factor.
  3. The World Health Organization defines adherence as the extent to which a person’s behavior – taking medication, following a diet, and/or executing lifestyle changes – corresponds with agreed recommendations from health care professionals.
  4. This scientific statement summarizes the current knowledge of medication non-adherence in relation to the national prevalence of poor BP control including methods for measuring medication adherence, risk factors for antihypertensive medications non-adherence and strategies for improving adherence to antihypertensive medications at the individual and the health system level.
  5. Several methods to assess adherence are described in this scientific statement including unstructured self-report or report by proxy, electronic drug monitors, direct observation, and biochemical detection of drug levels as examples.
  6. Factors associated with non-adherence include topical areas such as socioeconomic and demographic, therapy-related, healthcare system/team, patient-related, condition-related dimensions.
  7. Several interventions have been evaluated for improving medication adherence. These include patient education and counselling, medication regime management, reminders, monitoring and feedback, and incentives.
  8. To fully appreciate improvements in medication adherence, the limits within the construct of adherence must be considered Clinicians and patient behaviors relevant to adherence must be viewed within the broader context of society and the health care system. Within this notion are contributors such as nature and structure of our health insurance system, cost, access, literacy among is among others that are relevant to medication taking.
  9. Behavior of a health care professional must be considered in medication non-adherence. There is an assumption that if one health care professional prescribes an antihypertensive then another will continue the same treatment; this, as an example must be considered in evaluation of non-adherence.
  10. There is reason to be optimistic about adherence as interventions seem to be effective. Carefully examining all potential aspects of confounding what we believe we are seeing with non-adherence is critical to understanding the full picture of non-adherence. With this, tailoring the intervention to the barrier is also critical to successful adherence interventions.

Citation


Choudhry NK, Kronish IM, Vongpatanasin W, Ferdinand KC, Pavlik VN, Egan BM, Schoenthaler A, Houston Miller N, Hyman DJ; on behalf of the American Heart Association Council on Hypertension; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Medication adherence and blood pressure control: a scientific statement from the American Heart Association [published online ahead of print October 7, 2021]. Hypertension. doi: 10.1161/HYP.0000000000000203