Patients need advice, support and information from health professionals in order to be able to understand the importance of maintaining blood pressure control during the day, to use their drugs rationally, to learn how to deal with missed doses and how to identify adverse events and what to do when they occur. Sharing this responsibility with health professionals is a must - the patient does not need to cope alone.
There is a direct need for research to fill gaps in knowledge on adherence. In general such research should aim at gaining a better understanding of the determinants of adherence discussed above so that effective interventions that address barriers can be developed.
In addition, research should focus on the following important areas:
- validation and standardization of various measures of adherence to prescribed drug therapy and non-pharmacological therapy for hypertension;
- development of valid and reliable questionnaires to obtain information on determinants of adherence;
- investigation of health-related quality-of-life indicators related to patients' adherence to antihypertensive therapy;
- identification of predictors of adherence to pharmacological and non-pharmacological therapy;
- determination of the factors related to behaviour that influence adherence to antihypertensive therapy, such as patient preferences and patient beliefs;
- identifying common risk factors for nonadherence in patients with hypertension, in both developing and developed countries, to study strategies for improving patient adherence;
- understanding of behaviour change principles and mechanisms that promote adherence;
- development of interventions to promote adherence to antihypertensive medication;
- development of materials to involve patients more in managing and regulating their adherence and therefore their hypertension; and
- determination of the reductions in costs and hypertension-related complications resulting from adherence to antihypertensive therapy - issues that are relevant to the needs of patients, managed care organizations and governments.