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
Open this folder and view contentsSection I - Setting the scene
Open this folder and view contentsSection II - Improving adherence rates: guidance for countries
Close this folderSection III - Disease-Specific Reviews
Open this folder and view contentsChapter VII - Asthma
Open this folder and view contentsChapter VIII - Cancer (Palliative care)
Open this folder and view contentsChapter IX - Depression
Open this folder and view contentsChapter X - Diabetes
Open this folder and view contentsChapter XI - Epilepsy
Open this folder and view contentsChapter XII - Human immunodeficiency virus and acquired immunodeficiency syndrome
Close this folderChapter XIII - Hypertension
View the document1. Prevalence of adherence to pharmacotherapy in patients with hypertension
View the document2. Impact of adherence on blood pressure control and cardiovascular outcome
View the document3. Adherence to non-pharmacological treatment
View the document4. Factors contributing to adherence
View the document5. Interventions for improving adherence
View the document6. Conclusions
View the document7. References
Open this folder and view contentsChapter XIV - Tobacco smoking cessation
Open this folder and view contentsChapter XV - Tuberculosis
Open this folder and view contentsAnnexes
Open this folder and view contentsWhere to find a copy of this book

Chapter XIII - Hypertension

Clinical trials have demonstrated that the treatment of mild-to-moderate hypertension can reduce the risk of stroke by 30 to 43% (1 - 4) and of myocardial infarction by 15% (5). Other costly consequences of untreated hypertension can also be prevented or minimized by effective treatment. Examples of the benefits of treatment include reduction in risk of cardiac failure, reduction in incidence of dementia (6), preservation of renal function and prevention of blindness in diabetic patients with hypertension (7 - 9).

Traditionally, the term compliance has been employed to mean the extent to which the patient, when taking a drug, complies with the clinician's advice and follows the regimen (10). However, the new era of patient-oriented care has led to the use of this term being questioned, and alternative terms such as adherence, persistence and concordance have been suggested (11 - 14).

In addition to the confusing terminology in the area of adherence, there has been controversy over the use of 80% as a cut-off point to distinguish adherence from nonadherence. In most studies, nonadherence has been considered to occur when patients do not take ≥ 80% of their prescribed antihypertensive drugs (15,16).

Whatever the definition, poor adherence to treatment is the most important cause of uncontrolled blood pressure (13,14,17) and only 20 to 80% of patients receiving treatment for hypertension in real-life situations are considered to be "good compliers" (18).

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