SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE
8(12), 1-13. doi 10.1007/s12170-014-0415-4
Adherence to Antihypertensive Medications: Current Status and Future Directions
Joshua A. Rash, Kim L. Lavoie, Ross D. Feldman, Tavis S. Campbell
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Elevated blood pressure (BP) accounts for the largest global proportion of disease burden and is largely treatable through the use of antihypertensive medications. Adherence to antihypertensive medication may be defined as the extent to which patient behavior coincides with recommendations agreed upon by the health-care provider and the patient and encompasses initiation, implementation, and discontinuation. Despite the proven clinical efficacy of antihypertensive medications to control BP, approximately half of treated patients are nonadherent. Nonadherence to antihypertensive medications is a multifactorial concern. Barriers to antihypertensive medication adherence are numerous and include patient-related (e.g., beliefs about medication, motivation, mental health), provider-related (e.g., patient-provider communication, failure to appropriately escalate treatment), therapy-related (e.g., an asymptomatic disease, side effects, complexity of regimens), and system-related (e.g., medication cost, health literacy, uncoordinated delivery of services) influences. Several techniques to improve adherence to antihypertensive medications have been identified, with sufficient supporting evidence from randomized trials to inform clinical practice recommendations. This review summarizes the current understanding of the prevalence and impact of the failure to adhere to the medical management of hypertension. Factors linked to improved adherence and studies that assessed strategies to improve adherence are also summarized.