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Importance of adherence in the management of hypertension
1Jefe de Sección de la Unidad de Hipertensión, Servicio de Medicina Interna, Instituto Cardiovascular, IdISSC, Hospital Clínico San Carlos, Madrid, Spain.
Insights
Improving medication adherence in hypertension (HTN) is crucial for public health. Strategies like electronic prescriptions and fixed-dose combinations can significantly enhance patient adherence and reduce healthcare costs.
Area of Science:
- Public Health
- Cardiovascular Disease Research
- Health Economics
Background:
- Medication non-adherence is a major public health concern, leading to complications, reduced quality of life, drug resistance, and wasted resources.
- Hypertension (HTN) non-adherence rates are high, with significant treatment abandonment, impacting millions of deaths attributed to cardiovascular disease (CVD).
- CVD is projected to cause over 22 million deaths annually by 2030, highlighting the urgent need for effective interventions.
Purpose of the Study:
- To highlight the critical public health issue of medication non-adherence in hypertension.
- To present the validation of electronic prescriptions as a tool to measure adherence.
- To estimate the economic benefits of improved adherence to antihypertensive treatments.
Main Methods:
- Literature review and analysis of World Health Organization (WHO) data on non-adherence.
- Validation of electronic prescription technology against MEMS (Multi-Day Electronic Monitoring System) for HTN adherence.
- Predictive modeling in five European countries to estimate cost savings from increased adherence.
Main Results:
- Electronic prescription validation showed high sensitivity (87%) and specificity (93.7%) for HTN adherence.
- Increased adherence to 70% in antihypertensive treatment could save an estimated 332 million euros across five European countries over 10 years.
- Fixed combinations of two or three drugs were identified as an effective method to reduce non-adherence.
Conclusions:
- Improving medication adherence in hypertension is essential for public health and economic reasons.
- Electronic prescriptions offer a validated method for monitoring adherence in HTN management.
- Strategies like fixed-dose combinations and improved adherence can lead to substantial healthcare savings and better patient outcomes.
Abstract:
The WHO indicates that lack of adherence is a matter of the highest priority in Public Health, and is the main cause of not obtaining all the benefits that medications can provide; it is at the origin of medical and psychosocial complications; reduces quality of life; it increases the probability of the appearance of drug resistance and wastes healthcare resources. The no adherence prevalence in hypertension (HTN) ranges between 55.5% with self-reporting and 46.6% with pill counting, and treatment abandonment occurs in 18.5% of patients. The electronic prescription has been validated in HTN using MEMS as a comparison, with sensitivity of 87% and specificity of 93.7%, with an area under the curve of 0.903. In 2019, almost 10 million deaths were directly attributed to HTN. No other disease causes as high a number of deaths and has as high a projected increase in deaths as cardiovascular disease (CVD). By 2030, it is projected that more than 22 million people/year will die from CVD, almost 5 million more than in 2012. In a predictive model for a period of 10 years in five European countries (Italy, Germany, France, Spain and England), the potential savings of increasing adherence to antihypertensive treatment to 70% has been estimated at 332 million euros (80 million in the case of Spain). The use of fixed combinations of two or three drugs is a good method to reduce non-adherence.
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