Adherence to Long-Term Therapies - Evidence for Action
(2003; 211 pages) View the PDF document
Table of Contents
View the documentPreface
View the documentAcknowledgements
View the documentScientific writers
View the documentIntroduction
View the documentTake-home messages
Close this folderSection I - Setting the scene
Open this folder and view contentsChapter I - Defining adherence
Open this folder and view contentsChapter II - The magnitude of the problem of poor adherence
Close this folderChapter III - How does poor adherence affect policy-makers and health managers?
View the document1. Diabetes
View the document2. Hypertension
View the document3. Asthma
View the document4. References
Open this folder and view contentsSection II - Improving adherence rates: guidance for countries
Open this folder and view contentsSection III - Disease-Specific Reviews
Open this folder and view contentsAnnexes
Open this folder and view contentsWhere to find a copy of this book

2. Hypertension

It is well known that high blood pressure increases the risk of ischaemic heart disease 3- to 4-fold (27) and of overall cardiovascular risk by 2- to 3-fold (11). The incidence of stroke increases approximately 3-fold in patients with borderline hypertension and approximately 8-fold in those with definite hypertension (12). It has been estimated that 40% of cases of acute myocardial infarction or stroke are attributable to hypertension (13-15).

Despite the availability of effective treatments, studies have shown that in many countries less than 25% of patients treated for hypertension achieve optimum blood pressure (16). For example, in the United Kingdom and the United States, only 7% and 30% of patients, respectively, had good control of blood pressure (17) and in Venezuela only 4.5% of the treated patients had good blood pressure control (18). Poor adherence has been identified as the main cause of failure to control hypertension (19 - 25). In one study, patients who did not adhere to beta-blocker therapy were 4.5 times more likely to have complications from coronary heart disease than those who did (26). The best available estimate is that poor adherence to therapy contributes to lack of good blood pressure control in more than two-thirds of people living with hypertension (20).

Considering that in many countries poorly controlled blood pressure represents an important economic burden (e.g. in the United States the cost of health care related to hypertension and its complications was 12.6% of total expenditure on health care in 1998) (28), improving adherence could represent for them an important potential source of health and economic improvement, from the societal (29), institutional (30) and employers' point of view (31,32).

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