Medication non-adherence as a critical factor in the management of presumed resistant hypertension: a narrative review.
OBJECTIVE
Medication non-adherence is a crucial behavioural risk factor in hypertension management. Forty-three to 65.5% of patients with presumed resistant hypertension are non-adherent. This narrative review focuses on the definition of adherence/non-adherence, measurement of medication adherence, and the management of medication non-adherence in resistant hypertension using multilevel intervention approaches to prevent or remediate non-adherence.


RESULTS
A review of adherence and resistant hypertension literature was conducted. Medication adherence consists of three different yet related dimensions: initiation, implementation, and discontinuation. To effectively measure medication non-adherence, a combination of direct and indirect methods is optimal. Interventions to tackle medication non-adherence must be integrated in multilevel approaches. Interventions at the patient level can combine educational/cognitive (e.g., patient education), behavioural/counselling (e.g., reducing complexity, cueing, tailoring to patient's lifestyle) and psychological/affective (e.g., social support) approaches. Improving provider competencies (e.g., reducing regimen complexity), implementing new care models inspired by principles of chronic illness management, and interventions at the healthcare system level can be combined.


CONCLUSIONS
Improvement of patient outcomes in presumed resistant hypertension will only be possible if the behavioural dimensions of patient management are fully integrated at all levels.
Institute of Nursing Science, University of Basel, Basel, Switzerland.
Sabina
S
De Geest
Todd
T
Ruppar
Lut
L
Berben
Sandra
S
Schönfeld
Martha N
MN
Hill
D002908:Chronic Disease; D002986:Clinical Trials as Topic; D003695:Delivery of Health Care; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D055118:Medication Adherence; D010349:Patient Compliance; D012307:Risk Factors