Benefits of adherence to anti-hypertensive drug therapy

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Abstract
Long-term adherence or compliance with anti-hypertensive drug therapy is poor. It has been estimated that within the first year of treatment 16–50% of hypertensives discontinue their anti-hypertensive medications. Even among those who remain on therapy long term, missed medication doses are common. Epidemiological studies have shown that drug-treated hypertensives have higher blood pressures than age-, gender- and body mass index-matched normotensives. In addition, drugtreated hypertensive men and women who achieve blood pressure normalization are less likely to die over a 9·5-year period than those whose blood pressure remains elevated while taking anti-hypertensive drugs. Thus, one reason for less than optimal reduction of blood pressure-related cardiovascular-renal risk in drugtreated hypertensives is inadequate blood pressure lowering. Quantifiable excess risk has been documented even in the short term (P<0·01 compared with placebo). However, only 67·5%, 66·1% and 68·1%, respectively, of chlorthalidone, doxazosin and enalapril participants remained on these drugs as monotherapy at 48 months. Differential adherence to long-term anti-hypertensive drug therapy could translate into a greater risk of blood pressure-related complications and higher overall healthcare expenditures. Strategies to minimize the deleterious impact of therapeutic non-adherence with anti-hypertensive medications as well as the clinical and cost implications of the TOMHS data will be discussed.

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