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Compliance with pharmacological therapy in hypertension: can we do better, and how?

Journal of Human Hypertension volume 18, pages 595–597 (2004)Cite this article

Noncompliance with treatment has long been the plague of the national health-care system. Each year it is estimated that noncompliance with medication costs the UK economy billions of pounds, as a result of preventable hospital admissions and loss of productivity due to illness. In addition, noncompliance has been identified as the predominant reason for the failure of medical therapy and disease progression. Compliance has been defined as ‘the extent to which a person's behaviour coincides with medical care or advice’.1 In the management of hypertension, figures from the United States suggest that noncompliance with medication may be as high as 50–80%, with compliance decreasing rapidly over time.2, 3

Based on the current definition of hypertension (blood pressure (BP) of ⩾140/90 mm Hg),4 the 1998 Health Survey for England revealed that 42% and 33% of adult (⩾16 years) men and women, respectively, were hypertensive.5 Fewer than 10% of all UK hypertensive patients currently achieve the recommended target BP of <140/90 mmHg,6, 7 despite the well-known risks associated with hypertension and the overwhelming evidence from numerous clinical trials of the benefits of antihypertensive medication. A recent study, based on a meta-analysis of 61 prospective BP studies, calculated that if all hypertensive patients in the UK reduced their systolic BP to <140 mmHg, approximately 21 400 stroke deaths, 41 400 ischaemic heart disease (IHD) deaths, and 125 600 events (nonfatal stroke or IHD) could be prevented each year.7 Why then, in the face of such overwhelming evidence of the benefits of BP reduction, are less than one in 10 people in the UK achieving adequate control of their BP?

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  1. University Department of Medicine, City Hospital, Dudley Road, Birmingham, B18 7QH, UK

    G Thrall, G Y H Lip & D Lane

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  1. G Thrall
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  3. D Lane
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Correspondence to D Lane.

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Thrall, G., Lip, G. & Lane, D. Compliance with pharmacological therapy in hypertension: can we do better, and how?. J Hum Hypertens 18, 595–597 (2004). https://doi.org/10.1038/sj.jhh.1001722

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