How to Improve Patients’ Adherence to Antihypertensive Therapy: A Simple Solution for a Big Trouble

Worldwide control of essential hypertension is suboptimal. Several epidemiological studies and clinical surveys have independently and repeatedly shown that the proportions of treated hypertensive patients who achieved the recommended blood pressure (BP) targets (i.e., systolic/diastolic BP levels below 140/90 mm Hg) ranged from about 20% to 45% in the general population, with even lower proportions reported in high or very high cardiovascular risk individuals.1,2 Such estimations might be reconsidered after the publication of the latest sets of both North American and European guidelines on hypertension, which have redefined the BP targets to be achieved under pharmacological therapies in different age strata and clinical settings.3 Several explanations have been proposed to explain these disappointingly low rates of BP control recorded also in Western countries. Among the potential causes, the most commonly reported is the poor adherence to prescribed medications, which may heavily account for the lack of BP control in treated hypertensive patients.4 Indeed, it has been reported that about half of treated hypertensive patients did not keep the prescribed pharmacological therapies after 1 year and that about 3 quarters of treated patients did not have consultations from their general practitioners for repeated prescriptions after 2 years of treatment.5 This may lead to a substantially high proportion of patients with poorly treated, uncontrolled hypertension, who are exposed to higher risk of developing hypertension-mediated organ damage and major cardiovascular complications, including myocardial infarction, stroke, renal disease, congestive heart failure, and death, compared with controlled hypertensive patients. Therefore, lack of adherence to any antihypertensive therapy has become a key medical target, in order to achieve a reduction of hypertension-related cardiovascular burden, and new strategies are currently tested to fulfill this goal.