Noncardiovascular Illness as Barrier to Antihypertensive Treatment

Abstract

Control rates of hypertension vary from one country to another, but in general, they are much lower than would be desirable. In the United States, the National Health and Nutrition Examination Survey1 showed that the awareness of the hypertensive population improved from 50% in the 1970s to 70% in the 1990s. Over the same time interval, the proportion of treated hypertensive patients with normalized blood pressure rose from 10% to 29%. Recent studies in Europe2 and other parts of the world3 confirmed that the rule of halves still exists and that the fractions of hypertensive patients with properly controlled blood pressure range from ≈5% to 45%.4,5 Patients with high blood pressure not carrying out recommended therapy is a pervasive phenomenon that contributes worldwide to the low control rates of hypertension. Adherence, in a more judgmental way, also termed compliance, is the extent to which a patient’s behavior coincides with the clinical prescription.6 It usually increases with higher education, affluence, social support, and the frequency and quality of the interactions with the care providers, but it diminishes with the number of tablets to be taken.7 Other frequently cited reasons for not filling prescriptions are the …