Adherence course reduces hypertension

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 researchers 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 today 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 GBP80 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.