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European Heart Journal 1996 17(Supplement A):16-20; doi:10.1093/eurheartj/17.suppl_A.16
Copyright © 1996 by the European Society of Cardiology.
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© 1996 1996 The European Society of Cardiology

Benefits of adherence to anti-hypertensive drug therapy

J. M. Flack, S. V. Novikov and C. M. Ferrario

Wake Forest University, Bowman Gray School of Medicine Winston-Salem, North Carolina, U.S.A.

Correspondence: John M. Flack MD, MPH, Wake Forest University, Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1032, U.S.A.

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 (<1 year) after interruption or discontinuation of anti-hypertensive medications as total healthcare costs are higher, mostly because of higher hospitalization rates. Data from the Treatment of Mild Hypertension Study (TOMHS) are relevant to long-term adherence to various anti-hypertensive drug monotherapies. At 48 months, 82·5% and 77·8% of participants remained on amlodipine and acebutolol, respectively (both 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.

Key Words: Adherence • hypertension • TOMHS


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