Long-term adherence to antihypertensive therapy: a survey in four primary care clinics.
BACKGROUND
Many hypertensive patients have suboptimal control of their blood pressure. One of the most common causes is poor adherence with treatment.


OBJECTIVE
To identify factors associated with poorer adherence to antihypertensive treatment.


METHODS
The study was conducted in four urban clinics of Clalit Health Services (Israel's largest Health management organization): 3799 patients aged > 20 years with hypertension in whom a new antihypertensive medicine was started in a 3-year period were included. Data included: age; gender; chronic diseases; type of antihypertensive medicine; and adherence with treatment. Reasons for non-adherence had been evaluated in a random sample of 453 of the medical records.


RESULTS
Of the patients, 2234/3799 (58.8%) stopped >or= 1 medicine. Lower adherence was associated with female gender, new immigration, ischemic heart disease and being a non-diabetic. Adherence was related to the type of medicine. The highest rates of adherence were found with the use of angiotensin receptor blockers (59.1%) and selective beta-blockers (59%), and the lowest with non-selective beta-blockers (30.1%). There was no documentation of the reason to medicine cessation in 183/453 (40.4%) of the medical records. In 20.1% of cessations, the physician continued to prescribe the drug, despite the fact that the patient had stopped purchasing it. Common reasons for treatment cessation were side effects (15%) and lack of blood pressure control (5.5%).


CONCLUSIONS
Adherence with antihypertensive treatment declines with time and is associated with the type of medicine, and sociodemographic and clinical backgrounds. Family physicians must increase their documentation and awareness to medicine adherence.
Vinker
Shlomo
S
Central District, Clalit Health Services, Department of Family Medicine, Rishon LeZion, Israel. vinker01@zahav.net.il
Alkalay
Adi
A
Hoffman
Robert D
RD
Elhayany
Asher
A
Kaiserman
Igor
I
Kitai
Eliezer
E
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D054242:Emigrants and Immigrants / Q000523:psychology; D005260:Female; D006279:Health Maintenance Organizations; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007557:Israel; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data; D014505:Urban Population
D000959:Antihypertensive Agents