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Adherence to Pharmacologic Management of Hypertension

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Abstract

Adherence to pharmacologic therapy of hypertension is low (in the range of 50–70%) and has important implications both for blood pressure control and cardiovascular complications. Based on a review of the literature using the levels of evidence grading technique, determinants of adherence to the pharmacologic therapy of hypertension have been assessed. Additionally, interventions to improve compliance were evaluated. Patientcentred, health care provider-centred and drug-specific factors have all been shown to affect adherence rates. We conclude that the extent of adherence to pharmacologic therapy is modifiable. Measurable improvements in adherence can be obtained from simplified medication regimens and a combination of behaviour strategies, including the tailoring of pill-taking to patients’ daily habits and rituals, the advocacy of self-monitoring of pills and blood pressure, and the institution of reward systems.

Résumé

L’observance des pharmacothérapies pour le traitement de l’hypertension est faible (de l’ordre de 50 à 70 %) et a des implications importantes tant sur le contrôle de la tension artérielle que sur les complications cardiovasculaires. À partir d’un examen de la literature se servant des niveaux de la technique de graduation des preuves, on a évalué les determinants de l’observance des pharmacothérapies pour le traitement de l’hypertension. En outre, on a aussi évalué les interventions visant à améliorer l’observance. Les facteurs propres aux patients, aux soignants et aux médicaments ont tous indiqué qu’ils avaient une influence sur les taux d’observance. Nous en concluons que la portée de l’observance des pharmacothérapies est modifiable. Des améliorations mesurables de l’observance sont possibles grâce à des régimes médicamenteux simplifiés et à une combinaison de stratégies de comportement comprenant l’adaptation de la prise des médicaments aux habitudes et aux rituals quotidiens des patients, l’encouragement de l’autosurveillance de la tension artérielle et de la prise des médicaments, ainsi que l’établissement d’un système de récompenses.

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Authors and Affiliations

  1. Departments of Medicine, Physiology and Pharmacology & Toxicology, University of Western Ontario, London, Ontario, Canada

    Ross Feldman MD

  2. Pharmacy Department, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Marilyn Bacher BScPharm

  3. Departments of Medicine and Pharmacology & Toxicology, University of Calgary, Calgary, Alberta, Canada

    Norman Campbell MD

  4. Trinity-Conception Bay Medical Centre, Carbonear, Newfoundland, Canada

    Aidan Drover MD

  5. Health Promotions and Programs Branch, Health Canada, Ottawa, Ontario, Canada

    Arun Chockalingam PhD

Authors
  1. Ross Feldman MD
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  2. Marilyn Bacher BScPharm
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  3. Norman Campbell MD
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  4. Aidan Drover MD
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  5. Arun Chockalingam PhD
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Corresponding author

Correspondence to Ross Feldman MD.

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Feldman, R., Bacher, M., Campbell, N. et al. Adherence to Pharmacologic Management of Hypertension. Can J Public Health 89, I16–I18 (1998). https://doi.org/10.1007/BF03404494

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  • DOI: https://doi.org/10.1007/BF03404494

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