Maintaining long-term control of blood pressure: the role of improved compliance

Mild-to-moderate essential hypertension is a major risk factor for stroke and cardiovascular mortality and morbidity. Morbidity can be reduced significantly by lowering high blood pressure, and with the effective antihypertensive drugs now available, it is ever more important to identify and treat the estimated 50 to 60 million hypertensive persons in the United States. Yet a high percentage of persons being treated stop taking their medication and refuse to comply with their therapeutic regimen. Many problems relate to maintaining long-term therapy in the hypertensive population. They include the cost of medication, a lack of written instructions, unclear instructions, noninvolvement of the patient in designing the treatment plan, lack of patient education about the disease, side effects, and inconvenient dosing schedules. Numerous studies have found that compliance increases as drug-dosage frequency decreases, as with the use of once-daily or sustained-release drug preparations. Other contributors to compliance include prescription-refill reminders, appointment reminders, simple written instructions about drug use, and patient education about the need for treatment and the consequences of noncompliance. Many classes of antihypertensive drugs are available, and more are in development. With such an extensive armamentarium available, all patients, regardless of coexisting medical conditions, should be able to be given effective, individualized antihypertensive therapy.