Journal of the American Society of Hypertension
ASH Position PaperAdherence and persistence with taking medication to control high blood pressure
Section snippets
The Scope of the Problem
The most recent US survey data, obtained from randomly selected households, show that high BP awareness, treatment, and control rates have improved from 69%, 53%, and 26%, respectively, at the time of the 1988 to 1994 Nutrition Health and Examination Survey to 76%, 65%, and 37% between 2003 to 2004.1 In a recent Harris Interactive survey, more than two thirds of patients with hypertension said they are aware of their high BP and are in care and 90% were on treatment.2 Two major requirements for
Scientific Background
The scientific evidence to support the preceding statement of the problem comes from epidemiology, clinical trials, behavioral science and health services research, and systematic reviews. The original VA trial, the first to show the efficacy of oral medication to lower BP and reduce fatal complications of uncontrolled hypertension, was conducted in a hospital setting where a nursing staff initially directly administered antihypertensive medications to patients. After discharge, compliance was
Practical Considerations and Recommendations
There is clear potential to improve clinical outcomes by improving adherence and persistence with appropriate antihypertensive medications. It is essential that 4 strategies to maintain high BP control be integrated into effective health care policies that emphasize and improve prevention and management of chronic illness. (see Table)
Acknowledgments
This article was reviewed by David J. Hyman, MD, MPH, and Donald E. Morisky, ScD, MSPH, ScM. The American Society of Hypertension Writing Group Steering Committee: Barry J. Materson, MD, MBA, Chair; Henry R. Black, MD; Joseph L. Izzo, Jr., MD; Suzanne Oparil, MD; and Michael A. Weber, MD. Nancy H. Miller is a consultant for Boehringer Ingelheim and AstraZeneca. Martha Hill, RN, PhD and Sabina DeGeest, RN, PhD have nothing to disclose.
References (66)
- et al.
The clinical and economic burden of nonadherence with antihypertensive and lipid-lowering therapy in hypertensive patients
Value Health
(2009) - et al.
Community outreach
The National High Blood Pressure Education Program
- et al.
A conceptually based approach to understanding chronically ill patients’ response to medication cost pressures
Soc Sci Med
(2006) - et al.
Dunbar-Jacob J.Task force #4 – adherence issues and behavior changes: achieving a long-term solution. 33rd Bethesda Conference
J Am Coll Cardiol
(2002) - et al.
A conceptually based approach to understanding chronically ill patients' response to medication cost pressures
Soc Sci Med
(2006) - et al.
What evidence supports the use of computerized alerts and prompts to improve clinicians’ prescribing behavior?
J Am Med Inform Assoc
(2009) - et al.
Underserved urban African American men: hypertension trial outcomes and mortality during 5 years
Am J Hypertens
(2007) - et al.
Nursing clinics in the management of hypertension
- et al.
Effect of training and a structured office practice on physician-delivered nutrition counseling: the Worcester-Area Trial for Counseling on Hyperlipidemia (WATCH)
Am J Prev Med
(1996)
Hypertension treatment in a medicare population: adherence and systolic blood pressure control
Clin Ther
Trends in hypertension prevalence, awareness, treatment and control rates in the United States adults between 1988-1994 and 1999-2004
Hypertension
Hypertension management: results of a new national survey for the hypertension education foundation: Harris interactive
J Clin Hypertens
The quality of health care delivered to adults in the United States
N. Engl J Med
Adherence to prescribed anti-hypertensive drug treatments: longitudinal study of electronically compiled dosing histories
BMJ
The multilevel compliance challenge: recommendations for a call to action
Circulation
Adherence to long-term therapies: evidence for action
Patient adherence and medical treatment outcomes: a meta-analysis
Med Care
An ecological perspective on health promotion programs
Health Educ Q
A survey of primary care physicians in eleven countries, 2009: perspectives on care, costs, and experiences
Health Aff (Millwood)
Effects of treatment on morbidity in hypertension: results in patients with diastolic blood pressures averaging 115 through 129 mm Hg
JAMA
Major outcomes in high-risk hypertensives patients randomized to angiotensin-converting enzymes inhibitor or calcium-channel blocker versus diuretic: the Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
JAMA
Five-year findings of the Hypertension Detection and Follow-up Program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension
JAMA
Five year-findings of the Hypertension Detection and Follow-up Program. II. Mortality by race-sex and age
JAMA
Multiple risk factor intervention trial: risk factor changes and mortality results
JAMA
Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension
JAMA
The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. Results of the Trials of Hypertension Prevention, Phase I
JAMA
Strategies for patient education
Clinical Exp Hypertens
Barriers to antihypertensive medication adherence among adults—United States, 2005
Clin Hypertens (Greenwich)
Compliance with antihypertensive regimen: a review of the research in the 1980s
Ann Behav Med
Prescription drug co-payments and cost-related medication underuse
Health Econ Policy Law
Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure
Hypertension
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Reprinted with Permission from the Journal of Clinical Hypertension, Vol. 12, No. 10 October 2010, pgs. 757-764.
Conflict of interest: MNH: None. NHM—Boerhinger Ingelheim, Consultant, Astra Zeneca, Consultant. SDeG: None.