Skip to main content
SpringerLink
Log in

The effect of medication compliance on the control of hypertension

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

The effect of medication-taking patterns on blood pressure was investigated in 24 hypertensive outpatients being treated with once-daily doses of hydrochlorothiazide or chlorthalidone. Medication-taking patterns were measured with a small pill dispenser that electronically records the time of medication removal. Blood pressure reduction was found to correlate better with the total number of doses the patient removed from the pill pack during a month than with any of four other compliance measures that were based on the timing of dose removal. Analysis also suggested that blood pressure is improved if patients ingest omitted doses to “catch up” to the prescribed regimen. It is concluded that a simple pill count may be the most clinically relevant definition of compliance for patients with hypertension being treated with only hydrochlorothiazide or chlorthalidone, and that such patients should ingest all prescribed doses, regardless of the time interval between doses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Final Report of the Subcommittee on Definition and Prevalence of the 1984 Joint National Committee. Hypertension prevalence and the status of awareness, treatment, and control in the United States. Hypertension 1985;7:457–68

    Google Scholar 

  2. Gordon T, Kannel WB. Predisposition of atherosclerosis in the head, heart, and legs. The Framingham Study. JAMA 1972;221:661–6

    Article  PubMed  CAS  Google Scholar 

  3. Roberts WC. The hypertensive diseases. Evidence that systemic hypertension is a greater risk factor to the development of other cardiovascular diseases than previously suspected. Am J Med 1975;59:523–32

    Article  PubMed  CAS  Google Scholar 

  4. The Pooling Project Research Group. Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: final report of the pooling project. J Chronic Dis 1978;31:201–306

    Article  Google Scholar 

  5. Kannel WB, Wolf PA, McGee DL, Dawber TR, McNamara P, Castelli WP. Systolic blood pressure, arterial rigidity, and risk of stroke. The Framingham Study. JAMA 1981;245:1225–9

    Article  PubMed  CAS  Google Scholar 

  6. Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA 1967;202:1028–34

    Article  Google Scholar 

  7. Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA 1970;213:1143–52

    Article  Google Scholar 

  8. Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. III. Influence of age, diastolic pressure, and prior cardiovascular disease: further analysis of side effects. Circulation 1972;45:991–1004

    Google Scholar 

  9. Hypertension Detection and Follow-up Program Cooperative Group. 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 1979;242:2562–71

    Article  Google Scholar 

  10. Rudnick KV, Sackett DL, Hirst S, Holmes C. Hypertension in a family practice. Canad Med Assoc J 1977;117:492–7

    PubMed  CAS  Google Scholar 

  11. Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med 1984;100:258–68

    PubMed  CAS  Google Scholar 

  12. Sackett DL. Hypertension: V. Compliance with antihypertensive therapy. Can J Public Health 1980;71:153–6

    PubMed  CAS  Google Scholar 

  13. Non-compliance: does it matter? Br Med J 1979;2:1168

  14. O’Rourke RA. Physical examination of the arteries and veins (including blood pressure determination). In: Hurst JW (ed). The heart. New York: McGraw-Hill, 1986; 138–51

    Google Scholar 

  15. Eisen SA, Hanpeter JA, Kreuger LW, Gard M. Monitoring medication compliance: description of a new device. J Compliance in Health Care (in press)

  16. Evans L, Spelman M. The problem of non-compliance with drug therapy. Drugs 1983;25:63–76

    PubMed  CAS  Google Scholar 

  17. Sackett DL, Snow JC. The magnitude of compliance and non-compliance. In: Haynes RB, Taylor DW, Sackett DL (eds). Compliance in health care. Baltimore: Johns Hopkins University Press, 1979;11–22

    Google Scholar 

  18. Hulka BS, Cassel JC, Kupper LL. Disparities between medications prescribed and consumed among chronic disease patients. In: Lasagna L (ed). Patient compliance. Mount Kisco, New York: Futura Publishing Company; 1976: 123–52

    Google Scholar 

  19. Weintraub M, Au WY, Lasagna L. Compliance as a determinant of serum digoxin concentration. JAMA 1973;224:481–5

    Article  PubMed  CAS  Google Scholar 

  20. Rudd P. Medication packaging: simple solutions to nonadherence problems? Clin Pharmacol Ther 1979;15:257–65

    Google Scholar 

  21. Ramsey JA. Participants in noncompliance research: compliant or noncompliant? Med Care 1982;20:615–22

    Article  Google Scholar 

  22. Bergman AB, Werner RJ. Failure of children to receive penicillin by mouth. N Engl J Med 1963;268:1334–8

    Article  PubMed  CAS  Google Scholar 

  23. Lima J, Nazarian L, Charney E, Lahti C. Compliance with short-term antimicrobial therapy: some techniques that help. Pediatrics 1976;57:383–6

    PubMed  CAS  Google Scholar 

  24. Finney JW, Friman PC, Rapoff MA, Christophersen ER. Improving compliance with antibiotic regimens for otitis media. AJDC 1985;139:89–95

    PubMed  CAS  Google Scholar 

  25. Sackett DL, Haynes RB, Gibson ES, et al. Randomized clinical trial of strategies for improving medication compliance in primary hypertension. Lancet 1975;1:1205–7

    Article  PubMed  CAS  Google Scholar 

  26. Holford NHG. Clinical interpretation of drug concentrations. In: Katzung BG (ed). Basic and clinical pharmacology. Los Altos, California: Lange Medical Publications, 1984;780–7

    Google Scholar 

  27. Morgan TO, Adam WR, Hodgson N, Myers J. Duration of effect of different diuretics. Med J Aust 1979;2:315–6

    PubMed  CAS  Google Scholar 

  28. USP Dispensing Information. Volume I. Drug information for the health care provider. Rockville, MD: United States Pharmacopeial Convention, Inc. 1986;716

    Google Scholar 

  29. Gilman AG, Goodman LS, Rall TW, Murad F. The Pharmacological Basis of Therapeutics. Seventh edition. New York: MacMillan, 1986

    Google Scholar 

  30. Long JW. The essential guide to prescription drugs. New York: Harper and Row, 1985

    Google Scholar 

  31. USP dispensing information. Volume II. Advice for the patient. Drug information in lay language. Rockville, MD: United States Pharmacopeial Convention, Inc., 1986;7457

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Health Services Reserach and Development Service, St. Louis Veterans Administration Medical Center, USA

    Seth A. Eisen MD

  2. the Department of Medicine, Washington University School of Medicine, St. Louis, Missouri

    Seth A. Eisen MD

  3. Health Administration Program, Washington University School of Medicine, USA

    Robert S. Woodward PhD

  4. Department of Medicine, St. Louis University School of Medicine, St. Louis, Missouri

    Douglas Miller MD

  5. Department of Preventive Medicine and Public Health, Division of Biostatistics, Washington University School of Medicine, USA

    Edward Spitznagel PhD

  6. Department of Psychiatry, Washington University School of Medicine, USA

    Cynthia A. Windham MA

Authors
  1. Seth A. Eisen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert S. Woodward PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Douglas Miller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edward Spitznagel PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cynthia A. Windham MA
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported by the Health Services Research and Development Service, Veterans Administration, Washington, DC (HSR&D Grant #618).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eisen, S.A., Woodward, R.S., Miller, D. et al. The effect of medication compliance on the control of hypertension. J Gen Intern Med 2, 298–305 (1987). https://doi.org/10.1007/BF02596162

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02596162

Key words

Search

Navigation