Effect of general practitioner education on adherence to antihypertensive drugs: cluster randomised controlled trial
BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39360.617986.AE (Published 15 November 2007) Cite this as: BMJ 2007;335:1030All rapid responses
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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
Competing interests: No competing interests
Improving adherence to drugs for hypertension
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.
Competing interests: No competing interests