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Compliance, electronic monitoring and antihypertensive drugs
J M Mallion1, J P Baguet, J P Siche
1Department of Internal Medicine and Cardiology, Centre Hospitalier Universitaire, Grenoble, France.
Insights
Improving patient adherence to hypertension medication is crucial for reducing cardiovascular risks. Electronic pillboxes precisely measure adherence, revealing that patient education and once-daily dosing significantly enhance medication compliance.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Hypertension is a significant risk factor for cardiovascular morbidity and mortality.
- Antihypertensive treatment effectively reduces cardiovascular and cerebrovascular events, even with moderate blood pressure reduction.
- Current treatment success is limited, with only about 30% of hypertensive patients achieving normal blood pressure levels (< 140/90 mmHg).
Purpose of the Study:
- To investigate patient compliance with antihypertensive medication regimens.
- To evaluate the effectiveness of a novel electronic pillbox for precise compliance monitoring.
- To identify factors influencing compliance and explore methods for improvement.
Main Methods:
- Utilized an electronic pillbox with microprocessor to accurately record medication adherence.
- Monitored compliance over time, noting deterioration and identifying patient adherence patterns.
- Analyzed the impact of factors like dosing frequency and patient instruction on compliance.
Main Results:
- Medication compliance significantly impacts blood pressure reduction.
- Compliance deteriorates over time, dropping by approximately 50% within one year.
- Once-daily dosing and morning administration instructions improve compliance, while multiple daily doses reduce it.
- Patient age and activity levels appear to influence compliance patterns.
Conclusions:
- Electronic pillboxes offer a precise method for assessing medication adherence in hypertension management.
- Patient education, structured follow-up, and simplified dosing regimens are key to improving compliance.
- Targeted interventions can enhance adherence, leading to better blood pressure control and reduced cardiovascular event risk.
Abstract:
Hypertension, even of mild-to-moderate severity, is undoubtedly a risk factor for cardiovascular morbidity and mortality. It has been well demonstrated, in numerous studies that have been subjected to meta-analysis, that the introduction of antihypertensive treatment leads to reductions in cardiovascular and cerebrovascular events. These results can be obtained with even a moderate reduction in blood pressure, of the order of 4-5 mmHg in diastolic blood pressure. However, many studies have shown that the percentage of treated hypertensive individuals who have a reduction in blood pressure to normal values of systolic blood pressure/ diastolic blood pressure (< 140/90 mmHg) is of the order of 30%. The reduction in blood pressure data are well correlated with the level of compliance. This compliance can be defined as the adherence by the patient to the directions given by the doctor for medication dosage, and this can be considered as 'good' when it is of the order of 80%. Until recently the examination of compliance relied on questioning the patient, pill counts or ultimately blood sampling for drug levels, which could be used only in research. The use of an electronic pill box with a microprocessor in the cover that records the date and hour each time the box is opened is a precise method of recording compliance. The purpose of such a method is to study overall compliance, which deteriorates as time passes and falls by approximately 50% after 1 year. However, this compliance can be modified and improved if instruction and follow-up are given to the patient. Prescription compliance can be improved by once daily dosing and by instructing for this to be taken in the morning. In contrast compliance is considerably reduced when more than two doses are to be taken each day. Using the pill counting box allows us to describe and focus on different types of patients, ranging from rigidly adherent to completely chaotic. It seems that factors such as age and activity can influence these patterns of compliance.