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Patient Adherence and Treatment Intensification in Hypertension Management

In an observational study, patients whose blood pressure remained persistently elevated were likely to be nonadherent to their therapy.

Many patients with coronary artery disease who are receiving medical treatment for hypertension do not respond adequately to treatment. To study the effects of treatment intensification and patient nonadherence to drug regimens on blood-pressure control in this population, investigators analyzed data from a large, nonprofit, managed healthcare organization in Colorado.

Of a total of 10,447 patients with CAD who were treated for hypertension and for whom at least 12 continuous months of follow-up data were available, the investigators identified 5.3% with persistently high blood pressure over time. The mean systolic blood pressure in this group was 154 mm Hg at the initial visit and 152 mm Hg at the end of the study period. Just over 30% of the patients with persistently high blood pressure were nonadherent to their therapy, as indicated by a prescription fill rate of less than 80%; of these, two thirds had their treatment regimens intensified over the course of the observation period.

Comment: These findings highlight a current problem in blood pressure management: Many clinicians either do not have or do not benefit from information about whether their patients adhere to the therapies prescribed. We do not know whether the clinicians in this study asked their patients about adherence, but it seems inappropriate to intensify treatment in patients who are nonadherent to their current regimens, which occurred in a high proportion of the patients with persistently high blood pressure in this cohort. We need to develop systems in which information about patient adherence is both available to clinicians (e.g., via electronic records) and discussed with all patients who are not achieving their treatment goals.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology February 11, 2008

Citation(s):

Ho PM et al. Importance of therapy intensification and medication nonadherence for blood pressure control in patients with coronary disease. Arch Intern Med 2008 Feb 11; 168:271.

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