Practice 10-Minute Consultation

Poor adherence to antihypertensive drugs

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i3268 (Published 21 July 2016) Cite this as: BMJ 2016;354:i3268

This article has a correction. Please see:

  1. Mohammed Awais Hameed, clinical research fellow1 2,
  2. Indranil Dasgupta, consultant nephrologist1,
  3. Paramjit Gill, reader in primary care research3
  1. 1Heart of England NHS Foundation Trust, Birmingham, UK
  2. 2Institute of Applied Health Research, University of Birmingham, UK
  3. 3Primary Care Clinical Sciences, University of Birmingham, UK
  1. Indranil.dasgupta{at}heartofengland.nhs.uk
  • Accepted 20 May 2016

What you need to know

  • Non-adherence to antihypertensives and other drugs is common

  • If you identify non-adherence, discuss risks of untreated hypertension, expected benefits of drugs that lower blood pressure, and lifestyle changes using the patient’s personalised risk

  • Negotiate an achievable goal with the patient

A 56 year old man has had persistently raised blood pressure readings at home and in clinic since his diagnosis of hypertension three years ago. He was diagnosed after ambulatory blood pressure monitoring, and is prescribed four antihypertensives. At a routine blood pressure review he says not to bother with another prescription because he doesn’t take the drugs.

As many as half of patients with apparent resistant hypertension do not take their prescribed drugs.1 Consider non-adherence in those taking antihypertensives with elevated blood pressure readings particularly in those with apparent resistant hypertension, where blood pressure is persistently ≥140/90 mm Hg despite taking ≥3 titrated antihypertensive drugs including a diuretic. Biological resistant hypertension affects around 10% of those treated for hypertension in the United Kingdom, and such patients need specialist management. Attempt to identify and manage poor adherence before referring the patient to a specialist.

What you should do

To find out about adherence to drugs ask patients questions such as: “I know many people have difficulty taking their medicines, how do you manage yours?” or “Take me through your medications.”

The rate that patients are prescribed or collect their drugs can also provide information on adherence. In patients whose blood pressure remains uncontrolled despite multiple (≥3) antihypertensive drugs consider referral to a specialist hypertension clinic for directly observed therapy, …

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