Hypertension: addressing therapy adherence challenges

By Irene Vergos

Hypertension is a prevalent condition in Australia, affecting around one in three adults.¹Despite the availability of effective antihypertensive medications, adherence remains a significant challenge, impacting blood pressure control and increasing the risk of cardiovascular events.

Understanding non-adherence

Several factors contribute to poor adherence to antihypertensive therapy:

Asymptomatic nature of hypertension. Many patients don’t experience noticeable symptoms, leading to a perception that medication is unnecessary.

Side effects. Patients may experience some adverse effects, such as dizziness, fatigue, or frequent urination, which can discourage continued use.

Cost and accessibility. Financial constraints or difficulty accessing pharmacies can impede consistent medication use.²

Lack of understanding. Insufficient knowledge about hypertension and its risks may lead to undervaluing the importance of adherence.

Non-adherence may result in unnecessary medication adjustments, increased healthcare costs, and hospitalisations.^3,4 It can also lead to uncontrolled blood pressure, increasing the risk of:³

• Cardiovascular events. Including heart attacks and strokes.
• Kidney damage. Leading to chronic kidney disease.
• Cognitive decline. Due to vascular dementia.

Common classes associated with adherence issues 

Certain antihypertensive classes are more frequently linked to adherence challenges.⁵ To provide appropriate counselling and management strategies, it’s essential for pharmacists to understand these side-effect profiles.

Diuretics. Can cause increased urination, leading to inconvenience and potential electrolyte imbalances.

Beta-blockers.May result in fatigue, cold extremities, and sexual dysfunction.

Calcium channel blockers. Associated with peripheral oedema and constipation.

Enhancing adherence 

Pharmacists are well positioned to identify barriers, provide education and implement strategies to support patients in achieving optimal blood pressure control.

• Patient education 

Providing clear information about blood pressure, its risks, and the benefits of medication can empower patients to adhere to their treatment plans.

• Simplifying regimens 

Collaborating with prescribers to reduce dosing frequency or using combination pills can decrease the complexity of medication schedules.

• Addressing side effects 

Discussing potential side effects and offering alternatives can alleviate patient concerns and improve adherence.

• Utilising DAAs 

DAAs, such as pill organisers or blister packs, can help patients manage their medications effectively, particularly those with complex regimens.

• Regular follow-up

Scheduling periodic check-ins to monitor blood pressure and discuss any issues encourages ongoing engagement and adherence.

• Leveraging technology

Recommending mobile apps or reminder systems can assist patients in maintaining their medication schedules.

References 

1. gov.au/reports/heart-stroke-vascular-diseases/hsvd-facts/contents/risk-factors/high-blood-pressure
2. sagepub.com/doi/pdf/10.1177/23743735241241176
3. gov/cardiovascular-resources/php/medication-adherence/index.html
4. com/2227-9032/11/22/2979
5. org.au/assets/b4f87ca178ea0ffe-c20c76967dba-e00b9481bfb0a3dd8237ab770e962f2425b5bf325188a8f61019923c1a23.pdf

This article was first publishe in Retail Pharmacy September