Disclosures: Choudhry reports no relevant financial disclosures. Please see the statement for all other authors’ relevant financial disclosures.
October 07, 2021
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Tailored interventions needed to improve BP control, medication adherence

Disclosures: Choudhry reports no relevant financial disclosures. Please see the statement for all other authors’ relevant financial disclosures.
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Understanding the drivers of nonadherence to BP-lowering medications and tailoring interventions to these specific barriers may help to reduce the prevalence of uncontrolled hypertension in the U.S.

In a scientific statement published in Hypertension, an American Heart Association writing committee detailed a variety of drivers associated with poor adherence to BP-lowering medications and provided specific recommendations to address each barrier.

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“To reduce the massive risk for hospitalizations and deaths due to uncontrolled high blood pressure, specific attention is needed to understand why people don’t take their medicine as prescribed. It’s a factor that is highly modifiable,” Niteesh K. Choudhry, MD, PhD, professor of medicine at Harvard Medical School, executive director of the Center for Healthcare Delivery Sciences, associate physician in the division of pharmacoepidemiology and pharmacoeconomics, hospitalist at Brigham and Women’s Hospital and chair of the statement writing group, said in a press release. “There are many reasons a person doesn’t use or take medications properly, and a number of those reasons aren’t in their control. As we look for strategies to support people with high blood pressure, we need to consider solutions that address other contributors, including the role of health care professionals and the health care system.”

Barriers to medication adherence

According to the results from National Health and Nutrition Examination Survey, the prevalence of BP control in the U.S., defined as 140/90 mm Hg or lower, increased from 31.8% in 1999 to 53.8% in 2014. However, control has declined since 2014, with only 43.7% of adults with hypertension having it under control in 2018.

As Healio previously reported in 2020, the Office of the Surgeon General released a report on the significance of hypertension control as a national public health priority.

According to NHANES data cited in the statement, 39.4% of NHANES participants were unaware of having hypertension, 15.8% were aware but not using medication and just 44.8% were aware and receiving treatment.

According to the statement, the factors most often associated with nonadherence were related to patient socioeconomic factors and/or demographics; issues with the therapy or medication; issues with the health care system/care team relationship; patient-related issues such as visual or hearing impairments as well as lack of education; and condition-related such as disease severity or lack of symptoms.

“Evidence suggests that clinician failure to intensify medical regimens, often called clinical inertia, may be a greater contributor to uncontrolled BP than patient nonadherence to drug therapy,” the committee wrote.

The statement broke down medication adherence into three major phases: initiation, or failure to begin treatment; implementation, or not regularly taking prescribed doses of prescriptions; and persistence, or continuation of treatment.

Addressing barriers to adherence

According to the release, the writing committee presented the following interventions as solutions to promoting medication adherence:

  • Health systems should develop methods to measure medication adherence and offer resources to patients, adding that a pharmacy refill database is the best source of adherence information.
  • Real-time counseling, open-ended discussions, visual aids and patient diaries may improve health knowledge among patients with hypertension.
  • Utilizing newer technologies to integrate reminder notices, such as text messages or notifications with alert sounds, assist patients with medication adherence.
  • Evaluate ways to simplify the medication regimen, such as prescribing a polypill or a fixed-dose combination pill.
  • Insurance companies should reduce or eliminate co-pays for prescriptions to address the financial barrier to medication adherence.
  • Home BP monitoring is often more accurate and predictive of CV issues compared with in-office or hospital BP measurements.

Please see the statement for full details on the writing committee’s recommendations for improving adherence to BP lowering medications.

“Although past efforts aimed at improving adherence may have been disappointing, there is reason for optimism,” the committee wrote. “Recent interventions that target individuals who are documented to be nonadherent seem to be effective. It is likely that evidence on effective adherence interventions has been obscured by study designs that enrolled patients exclusively on the basis of elevated BP, including those on a suboptimal regimen. Accurately determining baseline adherence with established and evolving measurement techniques will likely be valuable in research and practice. Tailoring the intervention to the barrier is also likely to be critical to successful adherence interventions.”

Reference:

Health system crucial to improve medication adherence for people managing hypertension. https://newsroom.heart.org/news/health-system-crucial-to-improve-medication-adherence-for-people-managing-hypertension. Published in Oct. 7, 2021. Accessed on Oct. 7, 2021.