Antihypertensive medication in clinical practice : Aspects of patient adherence in treatment

Sammanfattning: Adherence to antihypertensive drug regimens is a well-documented determinant of blood pressure control. A review of the literature shows that little attention has been paid to how antihypertensive medication is managed in clinical practice.The aim of the empirical studies was to document and analyse the prerequisites of patient adherence to antihypertensive medication in routine clinical practice. The studies are based on two complementary sets of data, generated through intensive and extensive studies. In the intensive studies, audio-recordings (n=51) of follow-up appointments with hypertensive patients and their physicians were made in order to explore the nature of interaction ih routine clinical practice. Afterwards, patients (n=33) were interviewed to assess their knowledge of high blood pressure and antihypertensive medication. The extensive studies were population-based and carried out at Swedish primary health care centres (n=55) and clinics of internal medicine (n=ll). The intention of these studies was to assess perceived symptoms among hypertensive patients with (n=l 013) and without (n=l35) antihypertensive medication. Furthermore, concordance between the patients' and physicians' (n=212) views regarding risks of hypertension and benefits from antihypertensive medication was analysed.Most patients had a passive role and initiated few topics during the consultations. Little time was invested in discussing risks related to hypertension. The interviewed hypertensive patients had an unsatisfactory understanding of their condition and of the effects of the medication. The prevalence of perceived symptoms did not differ between patients with and without antihypertensive medication. Patients estimated the effects of medication to be more beneficial than did their physicians. Trade-offs between perceived benefits and side-effects of drug treatment showed that patients were generally unwilling to endure side-effects in return for long-term benefits of treatment. In routine clinical praxis, 14% of the antihypertensive medicated patients had reached a blood pressure o:;l40/90 mm Hg. Target values above 140/90 mm Hg were given for 63% of the patients by their physicians. Among patients who where aware of their target blood pressure, we found close agreement between the values given by patients and physicians. This implies that when the target blood pressure is communicated in clinical practice, the patients remember quite accurately.Better control of hypertension and coexisting risk factors is an essential objective in clinical practice. From the studies, two factors stood out as. important to improve adherence: more knowledge-sharing with the aim of increasing self-care competence and more effort to reduce side-effects of treatment.