Key result
Direct adherence monitoring detects over 2-fold higher nonadherence in resistant hypertension versus indirect methods.
Why the study?
Suboptimal adherence and nonadherence are common in resistant hypertension, where the greatest hurdle to prevention is accurately measuring and monitoring adherence across methods that vary substantially in accuracy and usage.
Medication nonadherence is a major cause of apparent treatment-resistant hypertension that is frequently underestimated by indirect assessment tools, underscoring the clinical value of objective biochemical drug monitoring and single-pill combinations.
Direct monitoring may better detect nonadherence in apparent resistant hypertension; leaves open need for prospective outcome trials before adoption.
Hypertension is one of the leading causes of death worldwide, and has been increasing in prevalence. A subset of hypertensive patients has resistant hypertension: blood pressure above goal despite taking three or more antihypertensive medications. While the diagnosis of true resistant hypertension requires medication adherence, many studies have found suboptimal adherence or complete nonadherence in resistant hypertensive patients. There are many factors that affect medication adherence, some more prevalent in the treatment of resistant and refractory hypertension, such as complex and expensive medication regimens. The greatest hurdle in preventing nonadherence is accurately measuring and monitoring adherence. There are various methods of monitoring medication adherence, both directly and indirectly, including questionnaires, pill counting, and blood plasma or urinary testing. These methods vary substantially in accuracy and common usage. This review covers the factors that affect adherence in resistant hypertensive patients and the methods used to assess adherence in these patients.
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Greer et al. (2026) conducted a review in Resistant and refractory hypertension. Direct and indirect medication adherence monitoring methods and adherence-improving strategies (fixed-dose combination pills, motivational interviewing) was evaluated on Medication nonadherence prevalence and blood pressure control. Direct adherence monitoring methods identify a higher prevalence of medication nonadherence (46%) in apparent treatment-resistant hypertension compared to indirect methods (20%).
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