Risk factors related to compliance

In the United States, half of the patient undergoing treatment for

hypertension drop out of care within a year of diagnosis and half of the patient who
remained under medical supervision took at least 80% of the prescribed
medications. 75% of the patients diagnosed with hypertension did not attain
optimum blood-pressure control due to poor adherence to antihypertensive
medications [k1]. In the Philippines, PRESYON 3 study from 2012 - 2013 revealed
that 75% of hypertensive aged 18 years old and above have medications while 25%
does not have medication. Among those who took antihypertensive drugs, 27%
have controlled blood pressure, 73% have uncontrolled. 57% of the hypertensive
adults were compliant while 43% were non-compliant. Among the non-compliant
patients, 19% took their medication sometimes, 15% mostly, 9% rarely and 1%
never took any drug. Among the compliant patients, 66% have controlled blood
pressures while 55% have uncontrolled. Among the non-compliant, 34% have
controlled blood pressures while 46% have uncontrolled [k2].
In 2003, the World Health Organization published a report entitled
Adherence to Long Term Therapies: Evidence for Action and the section on
hypertension identified several factors contributing to adherence. The two most
important factors for poor adherence are the asymptomatic and lifelong nature of
the disease. Low socioeconomic status, illiteracy and unemployment are important
risk factors for poor adherence. Other potential determinants of adherence may be
related to demographic factors such as age and education, patients understanding
and perception of hypertension, the health care providers mode of delivering
treatment, relationship between patient and health care professionals, health
system influences and complex antihypertensive drug regimens. Other patientrelated factors include understanding and acceptance of disease, perception of the
health risk regarding the disease, awareness of the costs and benefits of treatment,
active participation in monitoring and decision-making in the management of
hypertension. Good adherence is related to the aspects of drug treatment such as
drug tolerability, drug regimen complexity, costs and duration of treatment.
However there are discrepancies in the results obtained from randomized controlled
trial and observational studies regarding the adherence due to drug tolerability. In a
randomized controlled trial that recorded termination of medications due to adverse
effects, results showed that fewer patients discontinued thiazide diuretics than
beta-blockers and alpha-adrenergic blockers. In a recent observational study, initial
treatment with newer class of antihypertensive drugs such as ACE inhibitors and
calcium channel blockers promoted good adherence. [k1].

References:

K1 Sabat E, ed. Adherence to Long-Term Therapies: Evidence for Action.Geneva,

Switzerland: World Health Organization; 2003.
K2 Sison, J. et al PRESYON 3