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JCOM Abstract

J Clin Outcomes Manage 
2011 Aug;18(8):351-358
Medication adherence and persistence in hypertension management
Klootwyk JM, Sanoski CA

Abstract: Objective: To discuss barriers to adherence and persistence and present strategies for improving medication adherence and persistence in the management of hypertension. Methods: Review of the literature. Results: Despite the use of antihypertensive medication, blood pressure remains uncontrolled in a substantial percentage (46%) of patients with hypertension. One important cause of refractory hypertension is medication-taking behavior (ie, poor adherence and persistence to medication regimens). Rates of nonadherence to antihypertensive medications range from 9% to 37%, while nonpersistence has been found to occur at even higher rates (30% to 50%) in patients 12 months after the initiation of antihypertensive therapy. Modifiable factors for these medication-taking behaviors include high pill burden, drug tolerability, and drug costs. Selection of medications that are better tolerated, such as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, results in improved adherence and lower drug discontinuation rates compared to the use of the older, more poorly tolerated agents, diuretics and blockers. Once-daily medications and fixed-dose combinations are strategies that can be considered to lessen the pill burden in patients with hypertension. Coordination of medication initiation in hypertensive patients with concomitant illness also increases adherence in these patients. Conclusion: Clinicians should consider and implement strategies that address the modifiable factors that contribute to low adherence and persistence with hypertension treatment.

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