Compliance and the treatment of hypertension: where are we now?

Hypertension is a major risk factor for cardiovascular disease, and is associated with significant target-organ damage, such as left ventricular hypertrophy, renal disease, ischemic heart disease and cerebrovascular disease 1. The treatment (and control) of hypertension reduces cardiovascular risk and delays (or reverses) target-organ damage, where present. It is therefore of utmost importance that patients take their prescribed treatments regularly. Indeed, compliance with antihypertensive medications is one of the major factors that influences blood pressure control 2,3. Of note, hypertensive patients often require more than one agent to control their blood pressure. These patients often have associated comorbidities, which increase the number of pills that they are receiving. However, the higher the number of pills to be taken, the lower the compliance with medications 4. If drug compliance is poor, treatment effects are suboptimal and patients remain at risk of uncontrolled blood pressure and its complications. Various methods have been advocated in improving patient compliance. Among those suggested include the use of fixed-dose combinations of drugs (to reduce the number of pills), the use of long-acting formulations or drugs (to limit the number of doses per day and, hence, the number of pills), using drugs with lower side-effect profiles, and various types of ‘pillboxes’. In this issue of Therapy, the ELECTRA (Estudio sobre la eficacia de Lercanidipino y el Cumplimiento del Tratamiento) study examines the effects on compliance of using an electronic pillbox along with a long-acting, well-tolerated antihypertensive drug 5. In this study, more than 1500 hypertensive patients were treated with lercandipine (a long-acting calcium channel blocker), and randomized to ‘usual care’ or to