Journal of General Internal Medicine

, Volume 2, Issue 5, pp 298–305 | Cite as

The effect of medication compliance on the control of hypertension

  • Seth A. Eisen
  • Robert S. Woodward
  • Douglas Miller
  • Edward Spitznagel
  • Cynthia A. Windham
Original Articles

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.

Key words

medication compliance hypertension hydrochlorothiazide chlorthalidone 

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References

  1. 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;7:457–68Google Scholar
  2. 2.
    Gordon T, Kannel WB. Predisposition of atherosclerosis in the head, heart, and legs. The Framingham Study. JAMA 1972;221:661–6PubMedCrossRefGoogle Scholar
  3. 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;59:523–32PubMedCrossRefGoogle Scholar
  4. 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;31:201–306CrossRefGoogle Scholar
  5. 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;245:1225–9PubMedCrossRefGoogle Scholar
  6. 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;202:1028–34CrossRefGoogle Scholar
  7. 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;213:1143–52CrossRefGoogle Scholar
  8. 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;45:991–1004Google Scholar
  9. 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;242:2562–71CrossRefGoogle Scholar
  10. 10.
    Rudnick KV, Sackett DL, Hirst S, Holmes C. Hypertension in a family practice. Canad Med Assoc J 1977;117:492–7PubMedGoogle Scholar
  11. 11.
    Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med 1984;100:258–68PubMedGoogle Scholar
  12. 12.
    Sackett DL. Hypertension: V. Compliance with antihypertensive therapy. Can J Public Health 1980;71:153–6PubMedGoogle Scholar
  13. 13.
    Non-compliance: does it matter? Br Med J 1979;2:1168Google Scholar
  14. 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; 138–51Google Scholar
  15. 15.
    Eisen SA, Hanpeter JA, Kreuger LW, Gard M. Monitoring medication compliance: description of a new device. J Compliance in Health Care (in press)Google Scholar
  16. 16.
    Evans L, Spelman M. The problem of non-compliance with drug therapy. Drugs 1983;25:63–76PubMedGoogle Scholar
  17. 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;11–22Google Scholar
  18. 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: 123–52Google Scholar
  19. 19.
    Weintraub M, Au WY, Lasagna L. Compliance as a determinant of serum digoxin concentration. JAMA 1973;224:481–5PubMedCrossRefGoogle Scholar
  20. 20.
    Rudd P. Medication packaging: simple solutions to nonadherence problems? Clin Pharmacol Ther 1979;15:257–65Google Scholar
  21. 21.
    Ramsey JA. Participants in noncompliance research: compliant or noncompliant? Med Care 1982;20:615–22CrossRefGoogle Scholar
  22. 22.
    Bergman AB, Werner RJ. Failure of children to receive penicillin by mouth. N Engl J Med 1963;268:1334–8PubMedCrossRefGoogle Scholar
  23. 23.
    Lima J, Nazarian L, Charney E, Lahti C. Compliance with short-term antimicrobial therapy: some techniques that help. Pediatrics 1976;57:383–6PubMedGoogle Scholar
  24. 24.
    Finney JW, Friman PC, Rapoff MA, Christophersen ER. Improving compliance with antibiotic regimens for otitis media. AJDC 1985;139:89–95PubMedGoogle Scholar
  25. 25.
    Sackett DL, Haynes RB, Gibson ES, et al. Randomized clinical trial of strategies for improving medication compliance in primary hypertension. Lancet 1975;1:1205–7PubMedCrossRefGoogle Scholar
  26. 26.
    Holford NHG. Clinical interpretation of drug concentrations. In: Katzung BG (ed). Basic and clinical pharmacology. Los Altos, California: Lange Medical Publications, 1984;780–7Google Scholar
  27. 27.
    Morgan TO, Adam WR, Hodgson N, Myers J. Duration of effect of different diuretics. Med J Aust 1979;2:315–6PubMedGoogle Scholar
  28. 28.
    USP Dispensing Information. Volume I. Drug information for the health care provider. Rockville, MD: United States Pharmacopeial Convention, Inc. 1986;716Google Scholar
  29. 29.
    Gilman AG, Goodman LS, Rall TW, Murad F. The Pharmacological Basis of Therapeutics. Seventh edition. New York: MacMillan, 1986Google Scholar
  30. 30.
    Long JW. The essential guide to prescription drugs. New York: Harper and Row, 1985Google Scholar
  31. 31.
    USP dispensing information. Volume II. Advice for the patient. Drug information in lay language. Rockville, MD: United States Pharmacopeial Convention, Inc., 1986;7457Google Scholar

Copyright information

© Society of General Internal Medicine 1987

Authors and Affiliations

  • Seth A. Eisen
    • 1
    • 2
  • Robert S. Woodward
    • 3
  • Douglas Miller
    • 4
  • Edward Spitznagel
    • 5
  • Cynthia A. Windham
    • 6
  1. 1.Health Services Reserach and Development ServiceSt. Louis Veterans Administration Medical CenterUSA
  2. 2.the Department of MedicineWashington University School of MedicineSt. Louis
  3. 3.Health Administration ProgramWashington University School of MedicineUSA
  4. 4.Department of MedicineSt. Louis University School of MedicineSt. Louis
  5. 5.Department of Preventive Medicine and Public Health, Division of BiostatisticsWashington University School of MedicineUSA
  6. 6.Department of PsychiatryWashington University School of MedicineUSA

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