title: Do Patients With High Vascular Risk Take Antihypertensive Medication Correctly? Cumple-MEMS Study.
abstract: OBJECTIVE
  To assess compliance with treatment inhibit the renin-angiotensin system (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) in uncontrolled hypertension in patients at high cardiovascular risk.
  
  
  METHODS
  Prospective, longitudinal, multicenter study, carried out in 102 Spanish primary care centers. We included 808 uncontrolled hypertensive patients treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers who were at high vascular risk; 4 visits were conducted: baseline and 1, 3, and 6 months later. Compliance was measured by electronic monitors. We calculated the mean percentage compliance, the overall percentage of compliers, once-daily compliers, compliers with the prescribed time frame, and antihypertensive coverage. We considered a patient to be a complier when the percentage compliance was 80%-100%.
  
  
  RESULTS
  In all, 701 patients completed the study (mean age, 63.7 [11.1] years). The systolic and diastolic blood pressures decreased significantly (P<.0001) to 18.8 mmHg and 9.8 mmHg, respectively. The control rate was 70% (95% confidence interval, 65.6%-74.4%) (P=.0001). The rate of control was significantly higher among compliers than noncompliers (P<.05). The mean percentage of doses taken was 87.9% (95% confidence interval, 84.8%-91%) and the mean therapeutic coverage was 82.4% (95% confidence interval, 78.7%-86.1%). Overall, 73.3% of the patients were compliers (95% confidence interval, 69%-77.6%), 52.8% (95% confidence interval, 48%-57.6%) were once-daily compliers, and 46.5% (95% confidence interval, 41.9%-51.1%) complied with the prescribed time frame. Noncompliance was associated with a higher number of drugs prescribed (P<.001).
  
  
  CONCLUSIONS
  In hypertensive patients at high vascular risk, the rate of therapeutic noncompliance was very high, mainly when they took 5 or more pills daily.
authors.affiliation: Grupo de Trabajo sobre Cumplimiento e Inercia, Sociedad Española de HTA (SEH-LELHA), Madrid, Spain. emarquezc@papps.org
authors.forename: Emilio
authors.initials: E
authors.lastname: Márquez-Contreras
authors.forename: Mariano
authors.initials: M
authors.lastname: de la Figuera-Von Wichmann
authors.forename: Josep
authors.initials: J
authors.lastname: Franch-Nadal
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Llisterri-Caro
authors.forename: Vicente
authors.initials: V
authors.lastname: Gil-Guillén
authors.forename: José Luis
authors.initials: JL
authors.lastname: Martín-de Pablos
authors.forename: José Joaquin
authors.initials: JJ
authors.lastname: Casado-Martínez
authors.forename: Nieves
authors.initials: N
authors.lastname: Martell-Claros
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D018401:Sample Size; D013030:Spain; D016903:Drug Monitoring
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents