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How to screen for non-adherence to antihypertensive therapy

Gupta, Pankaj; Patel, Prashanth; Horne, Robert; Buchanan, Heather; Williams, Bryan; Tomaszewski, Maciej

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Pankaj Gupta

Prashanth Patel

Robert Horne

Bryan Williams

Maciej Tomaszewski


The quality of assessment of non-adherence to treatment in hypertensive is poor. Within this review, we discuss the different methods used to assess adherence to blood-pressure-lowering medications in hypertension patients. Subjective reports such as physicians’ perceptions are inaccurate, and questionnaires completed by patients tend to overreport adherence and show a low diagnostic specificity. Indirect objective methods such as pharmacy database records can be useful, but they are limited by the robustness of the recorded data. Electronic medication monitoring devices are accurate but usually track adherence to only a single medication and can be expensive. Overall, the fundamental issue with indirect objective measures is that they do not fully confirm ingestion of antihypertensive medications. Detection of antihypertensive medications in body fluids using liquid chromatography–tandem mass spectrometry is currently, in our view, the most robust and clinically useful method to assess non-adherence to blood-pressure-lowering treatment. It is particularly helpful in patients presenting with resistant, refractory or uncontrolled hypertension despite the optimal therapy. We recommend using this diagnostic strategy to detect non-adherence alongside a no-blame approach tailoring support to address the perceptions (e.g. beliefs about the illness and treatment) and practicalities (e.g. capability and resources) influencing motivation and ability to adhere.

Journal Article Type Article
Acceptance Date Sep 1, 2016
Online Publication Date Nov 26, 2016
Deposit Date Apr 3, 2017
Publicly Available Date Apr 3, 2017
Journal Current Hypertension Reports
Print ISSN 1522-6417
Electronic ISSN 1534-3111
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 18
Issue 12
Article Number 88
Keywords Hypertension, Uncontrolled hypertension, Non-adherence, Blood pressure medication
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