Long-term adherence to antihypertensive therapy: a survey in four primary care clinics.
ABSTRACT Many hypertensive patients have suboptimal control of their blood pressure. One of the most common causes is poor adherence with treatment.
To identify factors associated with poorer adherence to antihypertensive treatment.
The study was conducted in four urban clinics of Clalit Health Services (Israel's largest Health management organization): 3799 patients aged > 20 years with hypertension in whom a new antihypertensive medicine was started in a 3-year period were included. Data included: age; gender; chronic diseases; type of antihypertensive medicine; and adherence with treatment. Reasons for non-adherence had been evaluated in a random sample of 453 of the medical records.
Of the patients, 2234/3799 (58.8%) stopped >or= 1 medicine. Lower adherence was associated with female gender, new immigration, ischemic heart disease and being a non-diabetic. Adherence was related to the type of medicine. The highest rates of adherence were found with the use of angiotensin receptor blockers (59.1%) and selective beta-blockers (59%), and the lowest with non-selective beta-blockers (30.1%). There was no documentation of the reason to medicine cessation in 183/453 (40.4%) of the medical records. In 20.1% of cessations, the physician continued to prescribe the drug, despite the fact that the patient had stopped purchasing it. Common reasons for treatment cessation were side effects (15%) and lack of blood pressure control (5.5%).
Adherence with antihypertensive treatment declines with time and is associated with the type of medicine, and sociodemographic and clinical backgrounds. Family physicians must increase their documentation and awareness to medicine adherence.
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ABSTRACT: Hintergrund: Ein therapierefraktärer Hypertonus stellt ein häufiges Problem bei ambulanten Patienten dar und führt nicht selten im Rahmen hypertensiver Entgleisungen zur Krankenhauseinweisung. Ursächlich spielen neben nicht erkannten sekundären Hypertonieformen eine zusätzliche hypertensive renale Schädigung sowie Complianceprobleme eine wesentliche Rolle. Fallbeschreibung: Eine 75-jährige Frau wurde mit vermeintlich therapierefraktärem Hypertonus und Cephalgien stationär eingewiesen. Zwei Monate zuvor war eine Nierenarterienstenose ausgeschlossen und eine hypertensive Herzerkankung diagnostiziert worden. Bei der aktuellen Aufnahme fanden sich RR-Werte von 210/100 mmHg unter einer antihypertensiven Medikation mit 16 Dosen neun verschiedener Medikamente. Für endokrinologische Ursachen des Hypertonus gab es bei den Untersuchungen keinen Anhalt, in der nephrologischen Diagnostik fanden sich Hinweise auf eine hypertensive Nierenschädigung. Bei einer Tabletteneinnahme unter Aufsicht zeigten sich im Tagesverlauf normale bis hypotensive Blutdruckwerte, sodass die antihypertensive Medikation deutlich reduziert werden konnte. Eine 24h-Blutdruckmessung zeigte schließlich ein weitgehend normotensives Blutdruckverhalten. Nach intensiven Gesprächen zeigte sich schließlich, dass die Patientin die zeitliche und quantitative Einnahme der Antihypertensiva zuvor selbst sehr flexibel gestaltet hatte. Nach eingehender Aufklärung über die Notwendigkeit einer regelmäßigen Medikamenteneinnahme konnte die Patientin in die ambulante Betreuung entlassen werden. Schlussfolgerung: Ein vermeintlich therapierefraktärer Hypertonus sollte immer an ein Complianceproblem sowie an eine sekundäre hypertensive Nierenschädigung denken lassen. Background: Treatment-resistant hypertension is a common problem in an outpatient setting and often results in hospital admission. Non-identified secondary hypertension, hypertensive nephrosclerosis and non-compliance are major reasons for treatment resistance. Case Report: A 75-year old woman was admitted to the emergency room because of a hypertensive crisis with alleged treatment-resistant hypertension and progressive headache. Two months ago, renal artery stenosis had been ruled out and a diagnosis of hypertensive cardiomyopathy was established. On admission, the patient had a blood pressure of 210/100 mmHg despite an antihypertensive treatment with nine different drugs. Further investigations ruled out secondary hypertension due to an endocrine cause but were consistent with hypertensive nephrosclerosis. With a supervised drug intake the blood pressure was rather normal to hypotensive, resulting in the need for significant reduction of the antihypertensive medication. The apparent discrepancies were discussed in detail with the patient who finally admitted a previous inconsistent intake of the antihypertensive drugs. Following thorough training and education on the purpose of continued antihypertensive therapy, the patient could be discharged with a normotensive blood pressure profile. Conclusions: Therapy of treatment-resistant hypertension should always consider non-compliance and secondary hypertension as possible reason. Schlüsselwörter: Arterieller Hypertonus–Sekundärer Hypertonus–Non- Compliance–Nephrosklerose Key Words: Hypertension–Secondary hypertension–Non-compliance–Nephrosclerosis01/2010; 105(12):943-947. DOI:10.1007/s00063-010-1161-0
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ABSTRACT: In order to determine the perception of general practitioners (GPs) and specialists regarding their clinical experience with the use of the low-dose fixed combination of perindopril 2 mg plus indapamide 0.625 mg in hypertensive patients with diabetes, a multicenter survey carried out across Spain was performed. A total of 894 physicians (597 GPs and 297 specialists) participated in the survey. A total of 5126 patients were included (3434 in the GPs' group and 1692 in the specialists' group). Associated risk factors and organ damage were more frequently documented in the specialists' group. At baseline, 1.7% of the GPs' patients and 1.3% of the specialists' patients had their blood pressure controlled and with the combined therapy the blood pressure control rate attained 30.7 and 29.8%, respectively (p < 0.001 vs baseline and not significant intergroups). Less than 85% of physicians considered the efficacy and tolerability of combined therapy as 'good' or 'very good' but 93% of the patients were 'satisfied' or 'very satisfied' with combined therapy.Expert Review of Cardiovascular Therapy 10/2008; 6(8):1063-9. DOI:10.1586/14779072.6.8.1063
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ABSTRACT: Antihypertensive agents are one of the most commonly prescribed classes of medications in the country, but patient adherence rates are low. To better understand why rates are low, the authors used data from the 2005 HealthStyles survey and found that among the 1432 respondents who received prescriptions for antihypertensive medications, 407 (28.4%) reported having difficulty taking their medication. "Not remembering'' was the most common reason reported (32.4%), followed by cost (22.6%), having no insurance (22.4%), side effects (12.5%), other reasons (12.3%), not thinking there is any need (9.3%), and having no health care provider (4.7%). In a multivariate model, younger age, lower income, having mental function impairment, and having had a blood pressure check more than 6 months earlier were factors significantly associated with reporting difficulty taking prescribed antihypertensive drugs. Control of hypertension is a significant public health issue, and alleviating barriers to medication adherence should be a major goal toward hypertension management.Journal of Clinical Hypertension 01/2009; 10(12):922-9. DOI:10.1111/j.1751-7176.2008.00049.x · 2.96 Impact Factor