Impact of Nonadherence to Antihypertensive Therapy

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The benefits of antihypertensive therapy in reducing cardiovascular complications have been impressive. Several clinical trials in hypertension have shown that reduction of blood pressure is associated with significant decreases in the incidence of stroke, ischemic heart disease, congestive heart failure, and renal failure, irrespective of age, gender, race or ethnicity, type of antihypertensive used, or severity of hypertension.1 Nevertheless, control of hypertension remains unsatisfactory in the United States and throughout the world. Recent data from the National Health and Nutrition Examination Survey indicate that approximately 40% of hypertensive individuals are untreated, and 65% do not have their hypertension controlled to a blood pressure level of <140/90 mm Hg.2 Although control rates have improved in the past several years, the total number of patients with uncontrolled hypertension has actually increased because of the rise in hypertension prevalence during this period (Figure).3 Figure. Changes in the prevalence and control of hypertension in the United States (1988–2004). The total number of persons with uncontrolled hypertension has increased from 37 million to 42 million during the past 2 decades, even though the rate of control has increased from 27% to 35% during the same period. Data are from Cutler et al2 and Chobanian.3 Reprinted from Chobanian.3 Article see p 1598 The capability currently exists to lower blood pressure to goal levels in most hypertensive individuals. As with the treatment of other chronic illnesses in which long-term treatment is required, adherence to prescribed medications for hypertension can be a problem. Studies have shown that ≈50% of individuals discontinue antihypertensive medications within 6 to 12 months of their initiation.4 It has been assumed that inadequate adherence to antihypertensive medications and lack of persistence of therapy contribute to the development of cardiovascular complications, although little information has been available …