Pharmacologic treatment for hypertension may be required to reduce the risk of HF. Hypertension is recognized as a precursor to myocardial infarct and ventricular diastolic dysfunction, both of which are commonly found in HF patients. Hence hypertension and coronary artery disease are primary foci of HF risk prevention strategies (Drazner, 2011).
Assisting patients with medication management
Educating and assisting patients and family members with full medication adherence for hypertension is a major role for nurses. Medication adherence is a preferred term over medication compliance.
Definitions of adherence and nonadherence
Adherence is the process by which patients takes their medications as prescribed (Vrijens et al., 2012).
Non-adherence is defined as occurring when a patient does not obtain the prescribed medication, purchases the medication but does not take it as prescribed, or does not keep taking the medication as prescribed.
Main issues with nonadherence
Medication adherence has a significant treatment effect in reducing cardiovascular risk and heart failure. Mackenzie and MacDonald (2019), state poor adherence to antihypertensive medications, estimated to be between 20% to 80%, is a major factor in morbidity and mortality in patients with hypertension.
According to the AMA, the following are common reasons for nonadherence:
The National Community Pharmacists Association in their Medication Adherence report identified the following self-reported reasons for nonadherence to prescribed medications.
How to help patients with a medication regime that will work for them
There are a number of ways patients can be helped to take their medications in a timely and effective manner.
Health professionals who work with patients and families to support medication adherence can develop a check list for the patients to fill out to identify reasons for nonadherence.
Medication adherence can be particularly difficult with antihypertensive medications. Patients frequently have no symptoms from the hypertension but may have side effects from the medication. Encouraging patients to have a home blood pressure monitoring system and providing education on its use can be helpful. It is a visual demonstration of the positive effect of medication when taken consistently.
Detecting medication nonadherence
Healthcare professional who prescribe medications are concerned with measuring how much medication patients actually take. Avataneo et al. (2018) in their study of 50 patients found self-reporting of adherence to be unreliable. Health professionals ordering medication need to determine if the patient is being nonadherent or if the treatment needs to be changed.
Tomaszewski, et al. (2014) used high-performance liquid chromatography-tandem mass spectrometry urine analysis to assess antihypertensive drug intake with 208 hypertensive patients. The researchers found 25% of patients were totally (10%) or partially (15%) nonadherent to antihypertensive treatment.
According to Vrijens, et al. (2017) medication adherence by patients consists of three components: initiation, implementation, and persistence.
There are several methods to measure medication adherence
American Medical Association (2015). 8 reasons patients don't take their medications. https://www.ama-assn.org/delivering-care/patient-support-advocacy/8-reasons-patients-dont-take-their-medications
Avataneo, V., deNicolo, A., Rabbia, F., Perlo, E., Burrello, J., Berra, E., et al (2018). Therapeutic drug monitoring guided definition of adherence profiles in resistant hypertension and identification of predictors of poor adherence. Br J Clin Pharmacol 84, 2535–2543.
Drazner, M. (2011). The Progression of Hypertensive Heart Disease. Circulation 123(3), 327-34.
Mackenzie I. S., & MacDonald, T. M. (2019). Identifying poor adherence to antihypertensive medications in patients with resistant hypertension. Br J Clin Pharmacol, 85, 5–7.
National Community Pharmacists Association. (2013). Medication Adherence in America:A National report card. Alexandria, VA: NCPA.
Ruppar, T.M., Delgado, J.M. & Temple, J. (2015). Medication adherence interventions for heart failure patients: a meta-analysis. Eur J Cardiovasc Nurs 14, 395–404.
Tomaszewski, M., White, C., Patel, P., Masca, N., Damani, R., Hepworth, J., et al. (2014). High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis. Heart, 100, 855–861.
Vrijens,B., Antoniou, S., Burnier, M., de la Sierra, A. & Volpe, M. (2017). Current Situation of Medication Adherence in Hypertension. Front Pharmacol. 8, 100.