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A simple maneuver with the spygomanometer improves adherence to antihypertensive drugs
- Urs Schwarz (25 November 2007)
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Improving adherence to drugs for hypertension
- Kevin J Hardy, Sarah O'Brien and Shirley Hulme (29 November 2007)
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Urs Schwarz, General Physician 6932 Breganzona Switzerland
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I read with interest the research on the effect of general practitioner education on adherence to antihypertensive drugs (BMJ;335:1030-l033)and the editorial on improving adherence to drugs for hypertension (BMJ 335;335: 1oo2-1oo3).Fifteen years ago,while measurung handgrip strength in a patient with rheumatoid arthritis,it occurred to me to use that maneuvre to explain to a hypertensive patient what high blood pressure means for his cardiovascular system.The maneuvre goes as follows:the cuff of the sfigmomanometer is inflated to a pressure of approximatly 40 mmHg.The patient is asked to look at the scale of the manometer and to squeeze the cuff to reach a pressure of 110 mmHg and then 180 mmHg.He is then asked to repeat that maneuvre several times.He is told that his heart has to do this effort more than seventy thousand times a day,and that the vessel walls have to endure that pressure.Most patients remain deeply impressed by the difference in effort needed to pass from normal to high blood pressure.They easily understand the problem of high blood pressure and the benefits of antihypertensive treatment,This maneuvre is not very time-consuming,it can be done during a busy consultation and repeated later during treatment.Since using this method with my hypertensive patients,i have had no problems in convincing them to take their medication.Indirect signs of adherence,as reflected by pill- counting or by the lower heart rate in those patients taking beta- blockers,show me that the adherence of my patients with their medication has significantly improved.I suggest testing this simple maneuver in a prospective study. Competing interests: None declared |
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Kevin J Hardy, Consultant Diabetologist Whiston Hospital, Prescot, Merseyside, L35 5DR, UK, Sarah O'Brien and Shirley Hulme
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We read with great interest the study of Qureshi et al.(1) and the accompanying editorial in 17th November 2007 edition of the BMJ(2). As diabetes specialists with an interest in nephropathy, tight blood pressure control is a critical element of our patients’ management. Frequently, patients on multiple antihypertensive drugs remain sub-optimally controlled and we are faced with the therapeutic dilemma of whether to add further antihypertensive agents or to take additional steps to try to improve adherence to existing drugs. During a small, 12-month, randomised controlled trial of two different regimens for the introduction of antihypertensive drugs in 22 patients with diabetic nephropathy (target blood pressure < 125/75), we too monitored adherence with a medication event monitoring system. All patients in the trial received detailed verbal and written information about their medications and telephone support. At 12-months, blood pressure control was excellent (126/74 and 125/73), and of note, adherence was extremely good: mean percentage days correct number of doses taken 90% and 92%. Like Qureshi et al.(1), we cannot define exactly what element of the support we provided patients was associated with such good adherence, but we observe that in specialist care also, detailed explanation and support during treatment, coupled with regular follow-up was associated with excellent adherence to antihypertensive treatment and excellent blood pressure control. Competing interests: This work was supported by an unrestricted educational grant from Pfizer Pharmaceuticals. |
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