[No response to antihypertensive therapy: consider non-adherence].

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Hypertension management requires consistent medication adherence for optimal patient outcomes.
• Asymptomatic chronic conditions like hypertension often suffer from poor and declining adherence over time.
• Measuring drug adherence accurately presents significant challenges in clinical settings.

Observation:

• Three patients (two male, one female) presented with insufficiently effective blood pressure-lowering medication.
• Reasons for non-adherence included fear of side effects, unaddressed low plasma drug levels, and uncontrolled blood pressure despite multiple antihypertensives.
• One patient's blood pressure improved significantly with a single drug during hospitalization, but adherence did not improve with repeated instructions.

Findings:

• Patient-reported side effects, complex medication schedules, and depression are key risk factors for poor adherence.
• Simplifying medication regimens, regular patient-physician communication, and home blood pressure monitoring can enhance adherence.
• Involving specialized nurses and utilizing technology like email contact can support adherence improvement strategies.

Implications:

• Increased awareness of poor drug adherence is essential for enhancing hypertension treatment.
• Tailored interventions addressing individual patient barriers are necessary for effective medication management.
• Improving adherence is critical for reducing cardiovascular risk and improving long-term health outcomes in hypertensive patients.