title: Long-term adherence to antihypertensive therapy: a survey in four primary care clinics.
abstract: 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.
authors.affiliation: Central District, Clalit Health Services, Department of Family Medicine, Rishon LeZion, Israel. vinker01@zahav.net.il
authors.forename: Shlomo
authors.initials: S
authors.lastname: Vinker
authors.forename: Adi
authors.initials: A
authors.lastname: Alkalay
authors.forename: Robert D
authors.initials: RD
authors.lastname: Hoffman
authors.forename: Asher
authors.initials: A
authors.lastname: Elhayany
authors.forename: Igor
authors.initials: I
authors.lastname: Kaiserman
authors.forename: Eliezer
authors.initials: E
authors.lastname: Kitai
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents