Primary non-adherence occurred in 8% (95% CI 4-14%) of patients receiving a new antihypertensive prescription, and systolic BP reduction did not differ significantly based on adherence (p=0.19).
Cohort (n=207)
No
Does non-adherence to a new antihypertensive prescription affect blood pressure control at 4 months in adult patients with uncontrolled hypertension?
Primary non-adherence to newly prescribed antihypertensive medications occurs in 8% of patients, increasing to 24% by 4 months, highlighting a significant barrier to effective hypertension management.
Objective: Non-adherence is a major contributor to uncontrolled hypertension and cardiovascular risk. This study aims to assess 1) the rate of primary non-adherence based on pharmacy refill data; and 2) the association of non-adherence to a new prescription with blood pressure (BP) control. Design and method: This single-center, prospective cohort study included adult patients with a documented history of hypertension and an office BP >=140/90 mmHg (and/or). Primary non-adherence was defined as not dispensing a prescription within 30 days. Early non-adherence was defined as the proportion of days covered (sum of the days covered by the medication of interest during the follow-up period divided by the number of days in the follow-up period) <80% within the first 4 months. Repeat office BP measurements were performed after 4 months. Results: A total of 207 patients were enrolled, 61% were male, median age was 70 years IQR: 60–77, and median BP was 151/90 mmHg IQR: 145–164/IQR: 80–100, respectively, on a median of 2 IQR: 1–3 antihypertensive drugs. At baseline, 127 patients (61%) received a new prescription. Primary non-adherence was observed in 10 patients (8%; 95%–CI: 4–14%) and early non-adherence was observed in 31 patients (24%; 95%–CI: 17–33%). At 4 months BP control (<140/90 mmHg) was achieved in 67 patients (35%; 95%–CI: 28–43%) patients. A more pronounced decrease in office BP was observed in patients receiving therapy intensification (-13/-8 mmHg IQR: -26 to -3/-15 to -2), as compared to patients without therapy intensification (-9/-4 mmHg IQR: -20 to -1/-11 to 4)(systolic: p=0.06; diastolic: p=0.007). Throughout follow-up no further changes in antihypertensive medication were observed with a median change in defined daily dosage of 0 IQR:0–0 (p=0.92). BP reduction did not differ significantly between patients non-adherent to their new prescription (-21/-13 mmHg IQR: -35 to -3 /-19 to 0), as compared to those who were adherent (-13/-8 mmHg IQR: -24 to -3 /-14 to -2) (systolic: p=0.19; diastolic: p=0.33). Conclusions: Based on pharmacy refill data, primary non-adherence occurred in 8% of patients after receiving a new prescription for antihypertensive medication. At 4 months, non-adherence increased to 24% of patients.
Saville et al. (2026) conducted a cohort in Hypertension (n=207). New prescription for antihypertensive medication was evaluated on Primary non-adherence (not dispensing a prescription within 30 days) (95% CI 4-14). Primary non-adherence occurred in 8% (95% CI 4-14%) of patients receiving a new antihypertensive prescription, and systolic BP reduction did not differ significantly based on adherence (p=0.19).