Integrated approaches to management of hypertension: promoting treatment acceptance

Overwhelming trial evidence indicates that the treatment of hypertension is beneficial, but in practice, less than 50% of treated hypertensive subjects have blood pressure well controlled. The success of treatment relies on acceptance by the patient. Treatment acceptance may be affected by the efficacy and tolerability of drug therapy, its effects on quality of life, and other important but less well-recognized influences such as the expectations and preconceived ideas of the physician and the patient. This report briefly reviews the factors affecting patient concordance with antihypertensive treatment and the role these factors play in the development of an integrated treatment plan. Nonconcordance with drug therapy is common: Only one third of patients always take treatment, one third take it sometimes, and one third never take their prescribed medication. With poor concordance, control of blood pressure and the consequent benefits are less likely to be realized. The factors that influence concordance are ill understood. Although drug side effects and convenience of dosing regimens are contributors, the attitudes of patients, physicians, and their interactions are likely to be of considerable importance. Concordance may be improved by involving the patient in the treatment plan, setting explicit targets, following a clear treatment plan, motivating the patient to comply with treatment, paying attention to the concerns and particular needs of the individual patient, and by ensuring frequent contacts between patients and health care professions. Successful integrated approaches to the management of hypertension must address all the factors that affect treatment acceptance.