Adherence course reduces hypertension

ScienceDaily (Feb. 16, 2011) — A high proportion of patients with high blood pressure are failing to take their medication properly and would benefit clinically from a course of 'adherence therapy', according to new research from the University of East Anglia (UEA).

High blood pressure -- or hypertension -- is one of the major cardiovascular diseases worldwide. It leads to stroke and heart disease and costs more than $300 billion each year. Around a quarter of the adult population is affected -- including 10 million people in the UK.

Around half of patients with hypertension fail to reduce their blood pressure because they are not taking their prescribed medication correctly. Some cease taking their medication altogether, others only take some of it, and others do not follow the instructions to take their medicine after food, for example.

The reasons for this non-adherence are complex and include ambivalence about taking drugs, concerns over side effects, and complexity of treatment regimes. Previous attempts to improve adherence with information leaflets, monthly outpatient visits, reminders and self-monitoring have been shown to be mostly ineffective.

The UEA resesarchers studied 136 patients with high blood pressure in three outpatient clinics in Jordan. Half were given a course of seven weekly 'adherence therapy' sessions and half continued with their usual treatment. The 20-minute face-to-face sessions allowed a trained clinician to provide tailored information about the illness and treatment, and explore the patient's individual beliefs, fears and lifestyle.

Published February 16 in the Journal of Human Hypertension, the results show that the patients given adherence therapy took 97 per cent of their medications (compared with only 71 per cent for those given treatment as usual) and, on average, reduced their blood pressure by around 14 per cent -- taking it to just above the healthy range.

Lead author Prof Richard Gray of UEA's School of Nursing and Midwifery said: "Our findings suggest a clear clinical benefit in these patient-centred sessions.

"High blood pressure affects millions of people in both the developed and developing world and the problem is likely to increase dramatically over the next 15 years. Tackling the widespread failure to take medication correctly would lead to a major reduction in stroke and heart disease.

"If adherence therapy were a new drug it would be hailed as a potentially major advance in hypertension treatment."

Adherence therapy was originally developed by Prof Gray for patients with mental health problems who failed to take their medication correctly. The total cost of delivering a course of seven weekly sessions is calculated to be approximately £80 per person. Although the UEA study was not designed to formally evaluate cost effectiveness, other studies predict that a long-term reduction of blood pressure would lead to a reduction in stroke of 56 per cent and a reduction in chronic heart disease of 37 per cent -- suggesting that adherence therapy would likely be a cost-effective intervention.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of East Anglia, via EurekAlert!, a service of AAAS.

Journal Reference:

Fadwa Allalaiqa, Katherine Deane, Ahmed Nawafleh, Allan Clark and Richard Gray. Adherence therapy for medication non-compliant patients with hypertension: a randomised controlled trial. Journal of Human Hypertension, February 17 2011

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Medication adherence improves blood pressure control in chronic kidney disease

ScienceDaily (Nov. 3, 2010) — Researchers at the University of Cincinnati (UC) and the Cincinnati Veterans Affairs (VA) Medical Center have found that about one-third of chronic kidney disease patients who are prescribed therapies for high blood pressure do not often adhere to treatments.

This report was published in the Nov. 2 online edition of the American Journal of Nephrology.

The study, led by researchers at UC and the Cincinnati VA, showed that treatment of hypertension in patients with chronic kidney disease continues to be a challenge in their care and that by simply improving medication adherence, outcomes would improve greatly.

Chronic kidney disease is the slow loss of kidney function over time. The main function of the kidneys is to remove wastes and excess water from the body. Ongoing hypertension is often associated with kidney disease.

"Hypertension, or high blood pressure, is probably the most important modifiable risk factor in chronic kidney disease -- a precursor to end-stage renal disease that is associated with increased risk of morbidity and mortality," says Charuhas Thakar, MD, associate professor in the division of nephrology and hypertension at UC and chief of the renal section at the Cincinnati VA. "In chronic conditions, such as hypertension, whether or not a patient takes the correct dosage and amount of their hypertension medication is critical in reaching treatment goals.

"Patterns of medication adherence for these agents and their impact on blood pressure in practice settings were not previously well studied. We wanted to find out if medication adherence could make a difference on outcomes in kidney disease patients."

Using two years worth of data from patients seeking ambulatory care at the VA, researchers examined 7,227 chronic kidney disease patients who received at least one blood pressure medication prescription. Outpatient blood pressure measurements were averaged as high (more than 130/80 mm of Hg) versus normal, based on the national guidelines for hypertension management in kidney disease.

Medication adherence was calculated using medication possession ratio, meaning the actual treatment days divided by the total possible treatment days.

"Good versus poor medication adherence groups were compared for differences in demographic, co-morbid and laboratory variables," says Kristen Schmitt, chief of pharmacy at the Cincinnati VA and the lead author of the study. "Results showed that while 67 percent of patients took their medication properly, a total of 33 percent of patients had poor medication adherence. More importantly, those with poor adherence were 23 percent more likely to have sub-optimal blood pressure control during the entire two-year study period."

"With this data, we hope to develop a multidisciplinary approach to help kidney disease patients adhere to their prescribed blood pressure medications. This will not only improve their clinical outcomes but will also help in reducing costs of care," she continues.

"Although the results represent a large sample of patients, they are derived from a single center," adds Thakar. "Further investigations are needed to accurately assess the impact of medication adherence on cardiovascular and renal outcomes in practice."

This study was funded by a Federal Services Research Grant from the American Society of Health System Pharmacists (ASHP) Foundation.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Cincinnati Academic Health Center.

Journal Reference:

Kristen E. Schmitt, Christine F. Edie, Paul Laflam, Loretta A. Simbartl, Charuhas V. Thakar. Adherence to Antihypertensive Agents and Blood Pressure Control in Chronic Kidney Disease. American Journal of Nephrology, 2010; 32 (6): 541 DOI: 10.1159/000321688

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here