Adherence to antihypertensive treatment: a critical factor for blood pressure control

BACKGROUND: To compare rates of blood pressure (BP) control with the level of adherence to antihypertensive treatment and factors influencing compliance in Greek patients. DESIGN: An observational cross-sectional study on 1000 consecutively treated hypertensive patients, admitted to a University department of general surgery in a Greek hospital. METHODS: Patients were interviewed by the same doctor using pre-coded questionnaires with questions on demographic data, health and treatment status. Blood pressure was measured using a standard mercury sphygmomanometer. Treatment of hypertension was defined as current use of antihypertensive medication. Compliance was defined as an affirmative reply to a number of questions regarding regular use of antihypertensive medication according to the physician's instructions. RESULTS: Satisfactory BP control (levels <140/90 mmHg) was documented in only 20% of the treated hypertensives. Compliance to antihypertensive treatment was found in only 15% of the patients. Control of BP was positively associated with compliance. Compliance was more common among patients aged <60, city dwellers, the better educated, those more adequately counselled by their physicians and those followed by a private doctor. As regards treatment, compliance was better among those taking one antihypertensive tablet per day, those who had never changed their antihypertensive regimen and those who had never changed their doctor. CONCLUSIONS: Compliance is associated with more effective BP control. Physicians can enhance patient compliance and hypertension control by devoting more time to counselling, avoiding unnecessary changes in drug regimens and restricting the tablet numbers.