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PATIENT COMPLIANCE WITH ANTIHYPERTENSIVE THERAPY

Failure of patients to comply with antihypertensive drug regimens and to achieve adequate blood pressure control while on these regimens is, in part, the physician's fault. The physician's attitude may not always supply the support and motivation needed by a patient facing life-long therapy for a condition which may be asymptomatic. Physicians are trained for crisis intervention and often are not well equipped to treat diseases for long periods of time. And some physicians still consider asymptomatic hypertension a benign disease and therefore do not treat it aggressively. The goal of reaching normal (or near normal) blood pressures is not always taken seriously, and as a result patients on antihypertensive therapy are remaining hypertensive. A physician must take the time to explain to a newly diagnosed hypertensive patient why blood pressure must be lowered. A patient must be convinced of the need for therapy. Encouragement is needed for a patient to accept drug therapy, especially when it may produce unpleasant side effects. Patients need to know that if side effects appear, the drug dose can be reduced or an alternate agent can be tried.

A high proportion of patients drop out of therapy. A survey of private practice physicians in Georgia showed that more than 50% of hypertensive patients were lost to follow-up within 3 months. Why do patients drop out? They often stop because they do not understand the risks of untreated hypertension. If follow-up visits are scheduled at too frequent intervals, patients may become reluctant to return because of cost and inconvenience. During the first months of treatment, return visits can be scheduled for every 3-4 weeks, but once blood pressure is controlled, the time between visits can be lengthened. It is helpful to send the patient a card reminding him of a return visit.

Treatment must be as simple as possible. The patient's life style should not be drastically changed. Most patients will not adhere to rigid salt restrictions, and so a compromise goal should be set. Although home blood pressure readings are important for a small number of patients in whom control is difficult, for the majority of patients this procedure is undesirable. It tends to contribute to anxiety and to make the patient and/or his family overly blood pressure conscious.

Moser, M.: Clinical Medicine 82: 30 (Nov 1975)

INPHARMA 31st January, 1976 p2