Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Commentary
  • Published:

Does it matter whether patients take their antihypertensive medication as prescribed? The complex relationship between adherence and blood pressure control

Journal of Human Hypertension volume 20, pages 551–553 (2006)Cite this article

It is well recognized that blood pressure control is sub-optimal. For example, in the UK, 30% of the adult population are hypertensive, with a blood pressure over 140/90 mm Hg, or on blood pressure lowering medication.1 The ‘rule of halves’ continues to apply, with over half of hypertensives not on any treatment, and over half of the people who are on treatment having blood pressures over the 140/90 mm Hg threshold.1 It is regarded as almost axiomatic that a significant reason that blood pressure remains poorly controlled in people on treatment is their non-adherence with therapy. For example, the World Health Organization estimates that 50–70% of people do not take their antihypertensive medication as prescribed, and describes poor adherence as the ‘most important cause of uncontrolled blood pressure’.2 This orthodoxy is challenged by the findings of Schroeder et al.,3 reported in this issue. Schroeder et al. analysed the relationship between adherence over 6 months and achieved blood pressure in patients recruited from primary care who at baseline were on treatment for hypertension, but their blood pressure was over 150/90 mm Hg. Surprisingly, they found no relationship between medication adherence and achieved blood pressure, which suggests that adherence was not an important factor in this general practice population in explaining poor blood pressure control. The other interesting finding from these investigators was that adherence at baseline, measured by the strict method of timing compliance – that is, the percentage of doses taken at the correct time interval – was high, with mean timing compliance at just over 90%.4 Therefore, there are two questions raised by this research that need to be explored: Is adherence to medication in people with hypertension better than had been previously thought? And is it a significant factor in determining poor blood pressure control?

A systematic review of studies looking at compliance with blood pressure medication found overall mean ‘taking compliance’ of 94% for a once daily regime, and 88% for a twice daily regime.5 ‘Taking compliance’ is a slightly less strict criterion than timing compliance, as it simply reflects the percentage of prescribed doses taken, without specifying whether the dosing interval was correct. Nevertheless, Schroeder et al.'s results are broadly consistent with the findings of this systematic review. Indeed, a recent study set in primary care in Scotland also found over 90% adherence (defined as the number of days with treatment supply divided by the total number of days from the first prescription to the end of the study period).6

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Falaschetti E . Blood pressure. In: Sproston K, Primatesta P (eds). Health Survey for England 2003. TSO: London, 2004, pp 181–220.

    Google Scholar 

  2. World Health Organisation. Adherence to Long Term Therapies: Evidence for Action. WHO: Geneva, 2003.

  3. Schroeder K, Fahey T, Hay AD, Montgomery A, Peters T . Relationship between medication adherence and blood pressure in primary care: a prospective study. J Hum Hypertens 2006 [E-pub ahead of print: 16 March 2006; doi:10.1038/sj.jhh.1002011].

    Article  CAS  PubMed  Google Scholar 

  4. Schroeder K, Fahey T, Hollinghurst S, Peters TJ . Nurse-led adherence support in hypertension: a randomised controlled trial. Fam Pract 2005; 22: 144–151.

    Article  PubMed  Google Scholar 

  5. Wetzels GEC, Nelemans P, Schouten JS, Prins MH . Facts and fiction of poor compliance as a cause of inadequate blood pressure control: a systematic review. J Hypertens 2004; 22: 1849–1855.

    Article  CAS  PubMed  Google Scholar 

  6. Inkster ME, Donnan PT, MacDonald TM, Sullivan FM, Fahey T . Adherence to antihypertensive medication and association with patient and practice factors. J Hum Hypertens 2006; 20: 295–297.

    Article  CAS  PubMed  Google Scholar 

  7. Wetzels GEC, Nelemans PJ, Schouten JSAG, van Wijk BLG, Prins MH . All that gliters is not gold: a comparison of electronic monitoring versus filled prescriptions – an observational study. BMC Health Serv Res 2006; 6: 8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Waeber B, Leonetti G, Kolloch R, McInnes GT . Compliance with aspirin or placebo in the Hypertension Optimal Treatment (HOT) study. J Hypertens 1999; 17 (7): 1041–1045.

    Article  CAS  PubMed  Google Scholar 

  9. 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: 293–295.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Bourgault C, Senecal M, Brisson M, Marentette MA, Gregoire J-P . Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population based study. J Hum Hypertens 2005; 19: 607–613.

    Article  CAS  PubMed  Google Scholar 

  11. Chapman RH, Benner JS, Petrilla AA, Tierce JC, Collins SR, Battleman DS et al. Predictors of adherence with antihypertensive and lipid lowering therapy. Arch Intern Med 2005; 165: 1147–1152.

    Article  PubMed  Google Scholar 

  12. Osterberg L, Blaschke T . Adherence to medication. N Engl J Med 2005; 353: 487–497.

    Article  CAS  PubMed  Google Scholar 

  13. Schroeder K, Fahey T, Ebrahim S . How can we improve adherence to blood pressure lowering medication in ambulatory care? Systematic review of randomised controlled trials. Arch Intern Med 2004; 164: 722–732.

    Article  PubMed  Google Scholar 

  14. Esposti ED, Di Martino M, Sturani A, Russo P, Dradi C, Falcinelli S et al. Risk factors for uncontrolled hypertension in Italy. J Hum Hypertens 2004; 18: 207–213.

    Article  PubMed  Google Scholar 

  15. Lindholm LH . The problem of uncontrolled hypertension. J Hum Hypertens 2002; 16: S3–S8.

    Article  CAS  PubMed  Google Scholar 

  16. Berlowitz DR, Ash AS, Hickey EC, Friedman RH, Glickman M, Kader B et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998; 339: 1957–1963.

    Article  CAS  PubMed  Google Scholar 

  17. Phillips LS, Branch WT, Cook CB, Doyle JP, El-Kebbi IM, Gallina DL et al. Clinical inertia. Ann Intern Med 2001; 135 (9): 825–834.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Primary Care & General Practice, University of Birmingham, Birmingham, UK

    J Mant & R J McManus

Authors
  1. J Mant
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R J McManus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J Mant.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mant, J., McManus, R. Does it matter whether patients take their antihypertensive medication as prescribed? The complex relationship between adherence and blood pressure control. J Hum Hypertens 20, 551–553 (2006). https://doi.org/10.1038/sj.jhh.1002046

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1002046

This article is cited by

Search

Advanced search

Quick links