Suboptimal adherence, which includes failure to initiate pharmacotherapy, to take medications as often as prescribed, and to persist on therapy long-term, is a well-recognized factor contributing to the poor control of blood pressure in hypertension.
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Why is patient drug compliance important for long term hypertension?
Long term hypertension is associated with grave complications and therefore maintaining blood pressure within normal range is essential and ensuring patient's drug compliance is an important sector of patient … Compliance to Antihypertensive Medication: A Tertiary Care Study
Are patients with controlled hypertension more likely to adhere to antihypertensive medications?
Evidence supports the notion that patients with controlled hypertension are more likely to adhere to antihypertensive pharmacotherapy than are individuals with uncontrolled BP. 116, 117 Conversely, patients staying on therapy are more likely to achieve long-term BP targets. 118
What drives patients'non-compliance with hypertension treatment?
The last suggest that patients' non-compliance could be associated with reservations about drugs and lack of necessary knowledge on which to build an understanding of the condition and treatment. 6–8 We, therefore, decided to explore patients' opinions and expectations concerning hypertension and its treatment in another socio-cultural settings.
How do patient preferences affect medication compliance in hypertension?
Shared decision making in hypertension the impact of patient preferences on treatment choice. Medication compliance was also measured by prescription refills and defined as 80% or more of prescribed medication. Interestingly, there was no relationship between the outcome of decision analysis and a patient’s past adherence to medication.
What did patients complain about during a doctor's consultation?
Is non compliance a public health problem?
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Why is adherence a common problem for patients with hypertension?
Adherence matters. High adherence to antihypertensive medication is associated with higher odds of blood pressure control, but non-adherence to cardioprotective medications increases a patient's risk of death from 50% to 80%.
Why hypertensive patients do not comply with the treatment?
Patients had fears and negative images of antihypertensive drugs. The data also revealed a lack of basic background knowledge about hypertension. The clinical encounter was viewed as unsatisfactory because of its length, few explanations given by the physician and low physician-patient interaction.
Why is medication compliance a problem?
Poor adherence to appropriate medication therapy has been shown to result in complications, death, and increased health care costs. Medication adherence in patients with chronic conditions such as diabetes, hypertension, hyperlipidemia, asthma, and depression is a significant problem requiring intervention.
What is the most common reason for treatment failure of hypertension?
A frequent cause of failure to control blood pressure is the use of inappropriately low dosages of antihypertensive drugs.
How can hypertension increase compliance?
Reducing the number of daily doses appears to be effective in increasing adherence to blood pressure–lowering medication and should be tried as a first-line strategy, although there is less evidence of an effect on blood pressure reduction.
Why is medication adherence important?
Taking your medicine as prescribed or medication adherence is important for controlling chronic conditions, treating temporary conditions, and overall long-term health and well-being. A personal connection with your health-care provider or pharmacist is an important part of medication adherence.
What is compliance to medication regimen?
Medication compliance is defined as the extent to which a patient correctly follows medical advice (eg, treatment regimen, lifestyle tips, advice concerning disease management).
What are the barriers to medication compliance?
The barriers to medication adherence included four concepts, namely, lifestyle challenges, patient incompatibility, forgetting of medicine use, and nonexpert advice. These concepts are always present in the disease process and reduce the patients' efforts to achieve normal living and adhere to the medication.
What are some of the main barriers to patient compliance with pharmacological therapy?
Table 2Barrier to adherenceNumber of times citedPhysician/health system hurdlesChange to routine8,15,17,19,20,346Failure to consider patient's schedule when prescribing medicationPill burden, drug regimen too much8,9,11,15,17,22–27,31,3413Failure to simplify amount of medications and/or dosing frequency17 more rows•Jan 17, 2018
Why is it hard to control hypertension?
Other major causes of unresponsiveness to antihypertensive therapy include “white coat” hypertension, pseudohypertension, obesity, volume overload, excess alcohol intake and sleep apnea, as well as inappropriate antihypertensive drugs and drug combinations, and unfavorable interactions with prescription and other drugs ...
What is drug resistant hypertension?
Resistant hypertension is high blood pressure that does not respond well to aggressive medical treatment. Hypertension is considered resistant when all of the following are true: Someone is taking three* different blood pressure medications at their maximally tolerated doses.
What happens if you take too much high blood pressure medicine?
Diarrhea, severe heartburn, or persistent nausea. Erectile dysfunction (impotence) Extreme, persistent drowsiness, weakness or fainting. Falling due to dizziness when standing up.
What percentage of patients prefer not to take antihypertensive medication?
Forty-four percent of patients preferred not to take antihypertensive medication. Those who had less than a 10% 5-year risk of a cardiovascular event were slightly more likely to decline medication (62%) than those with a 10% or greater risk (50%). 39. Montgomery A.A.
What is the ethics of compliance?
The ethics of compliance suggests a conflict within the definition of compliance . Evidence-based medicine appears to provide clear pathways for clinical decisions, but, usually, the patient is not a part of the decision-making process. Physicians often develop a treatment plan and then attempt to make the therapy acceptable to the patient to achieve compliance. Interventions are tested to change patient behavior, but few are designed to consider the patient’s point of view. Some suggest that the ideal patient is passive and obedient. However, few patients are either. The individual’s perspective and goals most certainly affect adherence with a medical treatment and cannot be ignored. This article reviews the ethics of compliance/adherence issues. Future research of compliance might be improved if studies were designed to include patient preference in a partnership with physicians.
When are medical interventions justified?
In a study of the ethics of interventions for mild hypertension , there is detailed discussion about what is the best treatment, particularly when the immediate threat is low and the intervention may result in long-term morbidity.
What did patients complain about during a doctor's consultation?
The majority of patients complained about the length of the consultation. They claimed that little time was spent with regard to informing; indeed most of the consultation time was used just to get the prescription. In keeping with this, there was the perception of the physician as always being busy, and this was mentioned in several cases. In many cases, it was stated that physicians did not give any spontaneous information and asked few questions. In addition, it was emphasized that the physician seldom made eye contact during the consultation and spent the time just taking notes. Other statements were made to the effect that it was difficult to understand the physician's language or writing.
Is non compliance a public health problem?
Background. Medical non-compliance has been identified as a major public health problem in the treatment of hypertension. There is a large research record focusing on the understanding of this phenomenon. However, to date, the majority of studies in this field have been focused from the medical care perspective, but few studies have focused on the patients' point of view.
What are the factors that contribute to the poor control of blood pressure?
The global epidemic of hypertension is largely uncontrolled and hypertension remains the leading cause of noncommunicable disease deaths worldwide. Suboptimal adherence, which includes failure to initiate pharmacotherapy, to take medications as often as prescribed, and to persist on therapy long-term, is a well-recognized factor contributing to the poor control of blood pressure in hypertension. Several categories of factors including demographic, socioeconomic, concomitant medical-behavioral conditions, therapy-related, healthcare team and system-related factors, and patient factors are associated with nonadherence. Understanding the categories of factors contributing to nonadherence is useful in managing nonadherence. In patients at high risk for major adverse cardiovascular outcomes, electronic and biochemical monitoring are useful for detecting nonadherence and for improving adherence. Increasing the availability and affordability of these more precise measures of adherence represent a future opportunity to realize more of the proven benefits of evidence-based medications. In the absence of new antihypertensive drugs, it is important that healthcare providers focus their attention on how to do better with the drugs they have. This is the reason why recent guidelines have emphasize the important need to address drug adherence as a major issue in hypertension management.
What are the barriers to adherence to medication?
Complex regimens with multiple medications, especially when paired with multiple daily doses, are long-recognized as barriers to adherence. 6, 7, 11, 18 Alternatively, fewer medications, and especially fewer pills, which can be implemented using once daily single-pill combinations are consistently associated with better adherence and hypertension control. 45, 46 Patients who reach therapeutic targets more rapidly, who require fewer adjustments in their medication regimen, and who experience no or limited adverse effects are more likely to adhere than patients with a longer period to control, who often undergo multiple changes to their medication regimens, and experience adverse effects, are less likely to adhere to treatment. 6, 7, 11, 18 Long-term chronic diseases, such as hypertension, are often associated with progressive declines in persistence on treatment with the passage of months and years. 47, 48
What is an example of a common misunderstanding that adversely affects adherence?
One example of a common misunderstanding that adversely affects adherence is the term hypertension, which connotes too many patients that stress or behavioral issues are the root cause of the elevated BP. 58 In fact, patients with this perception of hypertension are less likely to take antihypertensive medications.
Why is BP control important for dementia?
Because BP control plays a role in the prevention of cognitive dysfunction and dementia, 134 a good adherence to antihypertensive should be favorable. Studies have demonstrated that it is possible to improve drug adherence in patients with cognitive dysfunction or dementia, but none has really demonstrate a clear impact on the reduction of health outcomes. 135
When was the first electronic medication monitoring system developed?
The first electronic monitoring system for medication adherence, known as the Medication Event Monitoring System (MEMS), was developed in 1977 . Its principle consisted in the incorporation of a microcircuit into medication packages such as any removal of a dose of the drug is detected in real time, time stamped, analyzed, stored, and communicated. Today, >750 articles involving over 1 million trial subjects have been published in peer-reviewed journals with this technique but its implementation in clinical practice remains limited to expert centers. The availability of dosing histories has repeatedly demonstrated that in ambulatory care, drug intake is characterized by a high irregularity with a wide spectrum of deviations from the prescribed regimen leading in general to an underdosing because of missed or delayed doses. 72 Interestingly, these observations were made across all therapeutic areas including chronic diseases, such as hypertension or dyslipidemia, but also life-threatening conditions, such as HIV, 73 organ transplantation, 74 or cancer chemotherapy. 75 Poor adherence or nonadherence was even reported in large clinical trials confounding sometimes the interpretation of the study results. 76–78 One general criticism to the electronic monitoring systems is the possibility that the system is activated while opening the pillbox but the dose is not taken. This is indeed the case, but when analyzing the data, the critical features are the nonopenings rather than the openings. In this respect, the system is analog to the determination of drug levels where the total absence of a compound is more relevant in terms of nonadherence than the actual presence of the drug. Moreover, studies comparing the MEMS data and the drug concentrations have shown that there is 97% accuracy between the 2 methods suggesting that when the pillbox is opened drugs are indeed taken. 79 Yet, in contrast to drug measurements, which are punctual, electronic monitoring systems provide additional information on drug-taking behaviors (taking, timing, frequency of omissions, compensatory intakes) based on the dosing history. Therefore, despite its limitation, electronic monitoring is one the most reliable technique to diagnose poor adherence and to follow and support adherence in chronic treatments. Several investigators have used the MEMS system to investigate the prevalence of poor adherence in hypertension. 80–82 Interestingly, in contrast to the general physicians’ perception, drug adherence was often found to be high (>90% adherence) although with a great variability and rather weak correlations between the level of adherence and that of BP. 83, 84 The main explanation for this apparent discrepancy between the perceived adherence and the measured adherence may be the measurement bias, as adherence tend to improve as soon as it is measured. The absence of strong correlation may also be because of the fact that high BP values can be found in nonadherent as well as in adherent patients if these latter are insufficiently treated. The measurement bias is particularly strong when the monitoring is of short duration and it tends to disappear over time.
Why are questionnaires used in clinical research?
Questionnaires have been developed to improve and structure self-reports. They are rarely used in everyday clinical practice mainly because they are time consuming . Nonetheless, questionnaires represent a good choice in clinical research, a context in which forms can be filled in by the patients themselves or by trained nurses or other healthcare professionals. Today, Nguyen et al 69 have identified >40 English-written adherence questionnaires, the most well-known being undoubtedly the Morisky questionnaire. 70 In general, questionnaires tend to overestimate true adherence and when compared with methods providing a complete dosing history, the correlation is rather low (well below 0.5) even for the Morisky questionnaire, although adherence determined by questionnaires tend to correlate with BP control. Yet, questionnaires are useful as a complement to more objective measures as they may provide additional information on the reasons why patients do not adhere or on the barriers encountered by patients during their medication-taking process. 69
Can hypertension cause poor adherence?
Resistant Hypertension. Although poor adherence can occur in all hypertensive patients whatever the number of drugs and the stage of hypertension, medication nonadherence is suspected mainly in clinical conditions where the prescribed treatment does not provide the expected reduction in BP.
What are the main goals of a medical history and physical examination for hypertension?
The main goals are to look for reversible precipitating factors, the presence and/or extent of end-organ damage, and the presence of additional cardiovascular (CV) risk factors, such as diabetes or smoking.
What is the first line of medication for hypertension?
First-line medications used in the treatment of hypertension include diuretics, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), beta-blockers, and calcium channel blockers (CCBs). Some patients will require 2 or more antihypertensive medications to achieve their BP target.
How do CCBs affect BP?
CCBs lower BP by preventing the entry of calcium into vascular smooth muscles, resulting in vasodilation and reduced vascular contract ility. The 2 types of CCBs are (1) dihydropyridines, which act on peripheral blood vessels, and (2) nondihydropyridines, which act on cardiac muscles and peripheral blood vessels.
How much did hypertension cost in 2009?
The total direct and indirect costs of hypertension in 2009 are estimated at $73.4 billion. ▸ Despite the many therapeutic options, most patients are still not at blood pressure goals. Instituting early preventive measures is essential to minimize complications associated with this costly condition.
What causes elevated BP?
Despite the prevalence of hypertension, approximately 90% to 95% of American adults with elevated BP are found to have no identifiable cause for their condition. Of the 5% with known causes, renal parenchymal and renovascular diseases are the most common culprits.1Other notable etiologies for hypertension include1: 1 Chronic kidney disease 2 Coarctation of the aorta 3 Cushing syndrome 4 Obstructive sleep apnea 5 Medications 6 Pheochromocytoma 7 Primary hyperaldosteronism 8 Renovascular disease 9 Thyroid/parathyroid disease.
What are the advantages of a fixed therapy regimen?
Advantages of fixed combination therapy include better compliance, fewer side effects, faster response, and possibly lower cost, depending on the choice of agents and the insurance programs. The combination of an ACE inhibitor or ARB with a diuretic is an effective and well-tolerated initial regimen.
Is hypertension a public health problem?
Hypertension is a significant and costly public health problem. It is a major, but modifiable contributor for the development of cardiovascular disease.
Why is medication adherence important for elderly?
Adherence is a major issue for the elderly population, as they present a higher risk of developing a diverse range of medical problems. When it comes to chronic conditions, and particularly those with an increased risk of premature death, medication adherence gains even more significance.
How long can you not take a prescription for chronic conditions?
In fact, half of those who have been prescribed treatment for such chronic conditions, will not take it for more than a year. Compliance in chronic conditions is difficult and physicians put in a lot of effort, in order to improve adherence in their patients.
How to improve medication adherence in elderly?
These are some solutions for increasing medication adherence in the elderly population: 1 Health education programs 2 Pro-active screenings for chronic conditions 3 Involving the patient in the decision-making process (if possible) 4 Involving caregivers and/or family members when establishing the treatment plan (+follow-up) 5 Community-based intervention for patient engagement. ( R)
How old do you have to be to take medication?
Older children, aged between 12 and 17 years old, will require medication as well, commonly for the treatment of chronic conditions. In children with life-threatening conditions, such as cancer or epilepsy, the rate of adherence varies between 50% and 60%, which is quite low.
Why should patients be educated?
Patients should be educated with regard to the importance of medication compliance, with self-awareness being obtained as a result . Health apps such as CareClinic can do wonders whereas compliance is concerned, as they are easy to use. Health education programs can reduce the costs associated with non-adherence.
What is simplification of medication plan?
Simplification of medication plan (for example, recommending a single dose per day) Improving the taste/formulation of the medication. Alternatives to pills (liquid form preferred) Frequent check-ups with the parents or other family members (adherence screening); counseling, health education and self-care plans.
What is non-adherence in healthcare?
Non-adherence has significant health implications, decreasing the overall quality of life and increasing the risk of premature death, as a result of poorly-managed symptoms . As part of the larger picture, non-adherence implies significant costs for the healthcare system.
When to use a diuretic before adding another class of medication?
A diuretic would be added before adding another class of medication unless the first drug was a diuretic . Vasodilators are generally used only in hypertensive emergencies. The nurse is caring for a patient with hypertension who is preparing to be discharged from the hospital after suffering a myocardial infarction.
What factors increase blood pressure?
Exposure to high-frequency noise. D. Factors that are known to increase blood pressure in some people include high levels of psychological stress, exposure to high-frequency noise, a high-salt diet, lack of rest, and genetic predisposition.
What is the first line of treatment for African Americans?
They are most responsive to single-drug therapy and diuretics. The first line use of a diuretic is in combination with diet and other lifestyle changes. The use of a calcium channel blocker and/or alpha-adrenergic blocker should follow. African Americans are less responsive to ACE inhibitors and beta-blocker.
What is the first line of diuretic?
The first line use of a diuretic is in combination with diet and other lifestyle changes. The use of a calcium channel blocker and/or alpha-adrenergic blocker should follow. African Americans are less responsive to ACE inhibitors and beta-blocker. Click again to see term 👆. Tap again to see term 👆.
What is the goal of drug therapy?
Helping the patient to maintain the blood pressure within normal limits is the goal of drug therapy. How blood pressure is maintained within normal limits may involve balancing fluid volume and patient compliance with the plan of care, but these are interventions and not the goal of therapy.
When to use losartan?
These drugs are used when blood pressure is extremely high and needs to be reduced quickly. The nurse cares for a diabetic patient with uncontrolled hypertension who has been prescribed losartan (Cozaar). The health care provider changes this patient's prescription to losartan with hydrochlorothiazide (Hyzaar).
Can you take more than one antihypertensive?
Many patients require more than one type of antihypertensive to achieve good control of their blood pressure. There are now many fixed-combination drugs available for treating hypertension. This allows for fewer tablets or capsules each day, making it easier for the patient to comply with drug therapy.
What did patients complain about during a doctor's consultation?
The majority of patients complained about the length of the consultation. They claimed that little time was spent with regard to informing; indeed most of the consultation time was used just to get the prescription. In keeping with this, there was the perception of the physician as always being busy, and this was mentioned in several cases. In many cases, it was stated that physicians did not give any spontaneous information and asked few questions. In addition, it was emphasized that the physician seldom made eye contact during the consultation and spent the time just taking notes. Other statements were made to the effect that it was difficult to understand the physician's language or writing.
Is non compliance a public health problem?
Background. Medical non-compliance has been identified as a major public health problem in the treatment of hypertension. There is a large research record focusing on the understanding of this phenomenon. However, to date, the majority of studies in this field have been focused from the medical care perspective, but few studies have focused on the patients' point of view.
Abstract
- Gascón JJ, Sánchez-Ortuño M, Llor B, Skidmore D and Saturno PJ for the Treatment Compliance in Hypertension Study Group. Why hypertensive patients do not comply with the treatment. Results from a qualitative study. Family Practice 2004; 21:125–130.
Introduction
- Hypertension is the single most common and most important risk factor for cardiovascular disease.1 Despite improvements in the detection and treatment of hypertension since the 1970s, recent survey results illustrate that the condition continues to contribute, significantly, to mortality and morbidity in adults and that it is often poorly controlled in clinical practice.2 Similarly, other …
Methods
- Participants
The target population comprised non-compliant hypertensive patients who were diagnosed with and receiving treatment for hypertension. Inclusion criteria were: anyone between the ages of 18 and 80 years, being treated with antihypertensives for >3 months, being non-compliant and havi… - Procedure
In order to determine whether or not the patient was compliant, a telephone survey was first conducted among 267 hypertensive patients, identified from clinic and computer records from two primary health care centres in Murcia (Spain). The Morisky–Green test10 was used in this s…
Results
- Factors identified as influencing treatment compliance fell into three categories: beliefs and attitudes about antihypertensive drugs; beliefs and attitudes about hypertension; and clinical encounters.
Discussion
- This study reveals a complex web of factors that can influence compliance behaviour within a group of patients diagnosed with hypertension (Figure 1). Although all the findings are not new with respect to previous literature, these serve to confirm what has been found previously, in the Spanish context. At first glance, the results indicated negative feelings towards medicines, low a…
Author Notes
- aDepartment of Preventive Medicine and Public Health, bDepartment of Basic Psychology and Methodology, cDepartment of Nursing, University of Murcia, Espinardo 30100, Murcia, Spain and dDepartment of Health Care Studies, Manchester Metropolitan University, Hathersage Road, Manchester M13 OJA, UK