Optimizing medication adherence in older persons with hypertension Article DOI:
Cite this article as: Elliott, W.J. Int Urol Nephrol (2003) 35: 557. doi:10.1023/B:UROL.0000025643.80319.b3 Abstract
Suboptimal control of hypertension in largecommunities can be attributed, in part, toabout 50% of patients who stop taking theirantihypertensive drugs after 1 year. Older patientswith many illnesses (including chronic kidneydisease) are at especially high risk for discontinuingprescribed medications, but age is a weaker predictor than the number of consumed pills.Determining if medications are being taken asprescribed is difficult, but asking the patientand significant other the simple question,``Have you missed any pills in the last week?''is a good place to start. Despite all theirother virtues, clinical trials seldom providethe same answers regarding medication adherencethat are found in clinical practice.Observational and a few interventional trialshave established that short, simple regimensthat improve patients' symptoms and arewell tolerated are more likely to be takencorrectly. Patient (and family) education isthe cornerstone of improving adherence tomedication, but several other interventionshave also proven useful. There appears to be no``magic bullet'' that will improve medicationadherence in all patients, but providingwritten instructions, simplifying themedication regimen to as few as necessary,once daily, well tolerated and inexpensivepills, involving family members, and promptingpill taking by certain activities of dailyliving all seem to help. Improving medicationadherence would be a simple way to makeantihypertensive therapies much morecost effective, since a medication that is nottaken incurs all of cost, and provides nobenefit to the patient.
Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 2003; 290: 199–203.
Erdine S. How well is hypertension controlled in Europe? J Hypertens 2000; 18: 1348–1349.
Berlowitz DR, Ash AS, Hickey C et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998; 339: 1967–1963.
McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA 2002; 288: 2868–2879.
Levine M. Costs associated with noncompliance. In: Leenen FHH, ed. Patient Compliance and the Long-Term Management of Hypertension. Québec, Canada: STA Communications, 1996: 21–28.
Elliott WJ. Compliance – and improving it – in hypertension. P&T Digest 2003; 12: 56–61.
Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications. JAMA 2002; 288: 2880–2883.
Morisky DE, Green LW and Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care 1986; 24: 67–74.
Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002; 288: 2981–2997.
Bloom BS. Continuation of initial antihypertensive medication after one year of therapy. Clin Ther 1998; 20: 671–681.
Conlin PR, Gerth WC, Fox J, Roehm JB, Boccuzzi SJ. Fouryear persistence patterns among patients initiating therapy with the angiotensin II receptor antagonist losartan versus other antihypertensive drug classes. Clin Ther 2001; 23: 1999–2010.
Dusing R, Weisser B, Mengden T, Vetter H. Changes in antihypertensive therapy – the role of adverse effects and compliance. Blood Pressure 1998; 7: 313–315.
Eisen SA, Miller DK, Woodward RS, Spitznagel E, Przybeck TR. The effect of prescribed daily dose frequency on patient medication compliance. Arch Intern Med 1990; 150: 1881–1884.
Iskedjian M, Einarson TR, MacKeigan LD et al. Relationship between daily dose frequency and adherence to antihypertensive pharmacotherapy: Evidence from ameta-analysis. Clin Ther 2002; 24: 302–316.
Caro JJ, Speckman JL, Salas M, Raggio G, Jackson JD. Effect of initial drug choice on persistence with antihypertensive therapy: the importance of actual practice data. CMAJ 1999; 160: 41–60.
Jones JK, Gorkin L, Lian JF, Staffa JA, Fletcher AP. Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population. BMJ 1995; 311: 293–296.
Rizzo JA, Simons WR. Variations in compliance among hypertensive patients by drug class: implications for health care costs. Clin Ther 1997; 19: 1446–1457.
Monane M, Bohn RL, Gurwitz JH, Glynn RJ, Levin R, Avorn J. The effects of initial drug choice and comorbidity on antihypertensive therapy compliance: results from a populationbased study in the elderly. Am J Hypertens 1997; 10: 697–704.
Salzman C. Medication compliance in the elderly. J Clin Psychiatry 1995; 56 (Suppl. 1): 18–22.
Perry HM Jr, McDonald RH, Hulley SB et al. The Systolic Hypertension in the Elderly Program, Pilot Study (SHEP-PS): morbidity and mortality experience. J Hypertension 1986; 4 (Suppl.): S21–S23.
Black DM, Brand RJ, Greenlick M, Hughes G, Smith J. Compliance to treatment for hypertension in elderly patients: The SHEP pilot study. Systolic Hypertension in the Elderly Program. J Gertontol. 1987; 42: 552–557.
Avorn J, Monette J, Lacour A et al. Persistence of use of lipid lowering medications: A cross-national study. JAMA 1998; 279: 1468–1462.
Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002; 388: 462–467.
Vivian EM. Improving blood pressure control in a pharmacistmanaged hypertension clinic. Pharmacotherapy 2002; 22: 1533–1540.
Chabot I, Moisan J, Gregorie JP, Milot A. Pharmacist intervention program for control of hypertension. Ann Pharmacother. 2003; 37: 1186–1193.
Mar J, Rodriguez-Artalejo F. Which is more important for the efficiency of hypertension treatment: hypertension stage, type of drug, or therapeutic compliance? J Hypertension 2001; 19: 149–155.
Google Scholar Copyright information
© Kluwer Academic Publishers 2003