Long-term adherence to therapy: the clue to prevent hypertension consequences: Figure 1

This editorial refers to ‘Adherence to antihypertensive therapy prior to the first presentation of stroke in hypertensive adults: population-based study’†, by K. Herrtua et al., on page 2933 Cardiovascular (CV) disease is the leading cause of death worldwide, accounting for 30% of all deaths, and arterial hypertension is the most important modifiable risk factor to diminish this burden.1 According to the latest Guidelines, daily compliance and long-term adherence to therapy are the most important aims for the adequate control of arterial hypertension.2 As can be seen in Figure 1, the most relevant reasons for a poor or low compliance depend in the first place on a poor relationship between doctor and patient preventing the latter from attaining an adequate understanding of the relevance of the disease and its consequences. This is particularly so if the patient has received only a low level of education and is not helped by his/her partner or family. Side effects of medications, complicated treatment schedules, memory or psychyatric problems, and elevated cost of medications will also contribute to make the patient poorly compliant. It is recognized that patients with hypertension or hyperlipidaemia tend to take less than half of their prescribed medications.3 However, few studies have investigated the relevance of a low adherence to treatment to the CV consequences of arterial hypertension, and none until the study of Herttua et al.4 has measured adherence repeatedly over a long period of time.