Updates to Adherence to Hypertension Medications

  • Paola C. Roldan
  • Grant Y. Ho
  • P. Michael Ho
Implementation to Increase Blood Pressure Control: What Works? (J Brettler and K Reynolds, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Implementation to Increase Blood Pressure Control: What Works?


Purpose of Review

The purpose of this review is to discuss recent studies that have described approaches or interventions to improve hypertension medication adherence and to suggest how providers can integrate evidenced-based approaches into routine clinical care to improve medication adherence and blood pressure control.

Recent Findings

Factors that can impact medication include patient-related factors, social- and economic-related factors, health system/health care team-related factors, and therapy-related factors. Overall, a multifaceted approach is needed to improve medication adherence. Important components include (1) patient education on hypertension, its treatment modalities and its long-term complications; and (2) patient engagement building on the foundation of education. The various interventions tested have engaged patients through interactive educational sessions, health coaching, motivational interviewing, stage of change behavioral counseling, and pharmacist hypertension management.


Strategies utilizing patient education and engagement are needed to improve medication adherence and blood pressure control.


Medication adherence Blood pressure Hypertension 


Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507–20.CrossRefPubMedGoogle Scholar
  2. 2.
    Egan BM, Li J, Hutchison FN, Ferdinand KC. Hypertension in the United States, 1999 to 2012: progress toward healthy people 2020 goals. Circulation. 2014;130:1692–9.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the United States: National Health and Nutrition Examination Survey, 2011–2012. NCHS data brief, no 133. Hyattsville, MD: National Center for Health Statistics. 2013.Google Scholar
  4. 4.
    Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr , Williamson JD, Wright JT Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017.Google Scholar
  5. 5.
    Collins R, MacMahon S. Blood pressure, antihypertensive drug treatment and the risks of stroke and coronary heart disease. Br Med Bull. 1994;50:272–98.CrossRefPubMedGoogle Scholar
  6. 6.
    Collins R, Peto R, MacMahon S, Godwin J, Qizilbash N, Collins R, et al. Blood pressure, stroke and coronary heart diseases. Part II: effects of short-term reduction in blood pressure—an overview of the un-confounded randomized drug trials in an epidemiological context. Lancet. 1990;335:827–38.CrossRefPubMedGoogle Scholar
  7. 7.
    Holman R, et al. Efficacy of atenolol and captopril in reducing the risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. Br Med J. 1998;317:713–20.CrossRefGoogle Scholar
  8. 8.
    Forette F, Seux ML, Staessen JA, Thijs L, Babarskiene MR, Babeanu S, et al. The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur) study. Arch Intern Med. 2002;162:2046–52.CrossRefPubMedGoogle Scholar
  9. 9.
    Costa FV. Compliance with antihypertensive treatment. Clin Exp Hypertens. 1996;18:463–72.CrossRefPubMedGoogle Scholar
  10. 10.
    World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003. p. 1–211.Google Scholar
  11. 11.
    Sackett DL, Haynes RB, Gibson ES, Hackett BC, Taylor DW, Roberts RS, et al. Randomised clinical trial of strategies for improving medication compliance in primary hypertension. Lancet. 1975;1:1205–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Lucher TF, et al. Compliance in hypertension: facts and concepts. Hypertension. 1985;3:S3–9.Google Scholar
  13. 13.
    •• Friedberg JP, Rodriguez MA, Watsula ME, Lin I, Wylie-Rosett J, Allegrante JP, et al. Effectiveness of a tailored behavioral intervention to improve hypertension control: primary outcomes of a randomized controlled trial. Hypertension. 2015;65(2):440–6. This study emphasizes a unique approach in providing patient-centered care through tailored phone counseling by non-physicians targeting a patient’s behaviors and self-confidence in diet, exercise, and medication adherence. CrossRefPubMedGoogle Scholar
  14. 14.
    Warren-Findlow J, Seymour RB, Brunner Huber LR. The association between self-efficacy and hypertension self-care activities among African American adults. J Community Health. 2012;37(1):15–24.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Criswell TJ, Weber CA, Xu Y, Carter BL. Effect of self-efficacy and social support on adherence to antihypertensive drugs. Pharmacotherapy. 2010;30(5):432–41.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Zullig LL, Peterson ED, Bosworth HB. Ingredients of successful interventions to improve medication adherence. JAMA. 2013;310(24):2611–2.CrossRefPubMedGoogle Scholar
  17. 17.
    Myers MG. Compliance in hypertension: why don’t patients take their pills? Can Med Assoc J. 1999;160:64–5.Google Scholar
  18. 18.
    Bloom BS. Continuation of initial antihypertensive medication after 1 year of therapy. Clin Ther. 1998;20:671–81.CrossRefPubMedGoogle Scholar
  19. 19.
    Bernheim SM, Ross JS, Krumholz HM, Bradley EH. Influence of patients’ socioeconomic status on clinical management decisions: a qualitative study. Ann Fam Med. 2008;6(1):53–9.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Ross JS, Bradley EH, Busch SH. Use of health care services by lower-income and higher-income uninsured adults. JAMA. 2006;295(17):2027–36.CrossRefPubMedGoogle Scholar
  21. 21.
    Schootman M, Jeffe DB, Baker EA, Walker MS. Effect of area poverty rate on cancer screening across US communities. J Epidemiol Community Health. 2006;60(3):202–7.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Brown AF, Gross AG, Gutierrez PR, Jiang L, Shapiro MF, Mangione CM. Income-related differences in the use of evidence-based therapies in older persons with diabetes mellitus in for-profit managed care. J Am Geriatr Soc. 2003;51(5):665–70.CrossRefPubMedGoogle Scholar
  23. 23.
    Yelin E, Trupin L, Yazdany J. A prospective study of the impact of current poverty, history of poverty, and exiting poverty on accumulation of disease damage in systemic lupus erythematosus. Arthritis Rheum. 2017;69:1612–22.CrossRefGoogle Scholar
  24. 24.
    Alter DA, Naylor CD, Austin P, Tu JV. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med. 1999;341(18):1359–67.CrossRefPubMedGoogle Scholar
  25. 25.
    Schold JD, et al. Barriers to evaluation and wait listing for kidney transplantation. CJASN. 2011;7(6):1760–7.CrossRefGoogle Scholar
  26. 26.
    Materson BJ, Reda DJ, Cushman WC, Massie BM, Freis ED, Kochar MS, et al. Single drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affair Cooperative Study group on Antihypertensive Agents. N Engl J Med. 1993;328:914–92.CrossRefPubMedGoogle Scholar
  27. 27.
    Leenen FH, Wilson TW, Bolli P, Larochelle P, Myers M, Handa SP, et al. Patterns of compliance with once versus twice daily antihypertensive drug therapy in primary care: a randomized clinical trial using electronic monitoring. Can J Cardiol. 1997;13:914–20.PubMedGoogle Scholar
  28. 28.
    Eisen SA, Miller DK, Woodward RS, Spitznagel E, Przybeck TR. The effect of prescribed daily dose frequency on patient medication compliance. Arch Intern Med. 1990;150:1881–4.CrossRefPubMedGoogle Scholar
  29. 29.
    McInnes GT. Integrated approaches to management of hypertension: promoting treatment acceptance. Am Heart J. 1999;138:S252–5.CrossRefGoogle Scholar
  30. 30.
    Kruger SH, Gerber JJ. Health beliefs and compliance of black South African outpatients with antihypertensive medication. J Soc Adm Pharm. 1998;15(3):201–9.Google Scholar
  31. 31.
    Saounatsou M, Patsi O, Fasoi G, Stylianou M, Kavga A, Economou O, et al. The influence of the hypertensive patient’s education in compliance with their medication. Public Health Nurs. 2001;18(6):436–42.CrossRefPubMedGoogle Scholar
  32. 32.
    Lu C-H, Tang ST, Lei YX, Zhang MQ, Lin WQ, Ding SH, et al. Community-based interventions in hypertensive patients: a comparison of three health education strategies. BMC Public Health. 2015;15:33.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Johnson AL, Taylor DW, Sackett DL, Dunnett CW, Shimizu AG. Self-recording of blood pressure in the management of hypertension. Can Med Assoc J. 1978;119:1034–9.PubMedPubMedCentralGoogle Scholar
  34. 34.
    West DS, DiLillo V, Bursac Z, Gore SA, Greene PG. Motivational interviewing improves weight loss in women with type 2 diabetes. Diabetes Care. 2007;30:1081–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Dilorio C, et al. Using motivational interviewing to promote adherence to antiretroviral medications. J Assoc Nurses AIDS Care. 2003;14:52–62.CrossRefGoogle Scholar
  36. 36.
    • Ogedegbe G, Chaplin W, Schoenthaler A, Statman D, Berger D, Richardson T, et al. A practice-based trial of motivational interviewing and adherence in hypertensive African Americans. Am J Hypertens. 2008;21(10):1137–43. This study highlights how motivational interviewing counseling as well as pill monitors may help to motivate patients to adhere to medications and health behaviors. CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Carter BL, Ardery G, Dawson JD, James PA, Bergus GR, Doucette WR, et al. Physician and pharmacist collaboration to improve blood pressure control. Arch Intern Med. 2009;169:1996–2002.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Carter BL, Coffey CS, Ardery G, Uribe L, Ecklund D, James P, et al. A cluster-randomized trial of a physician\pharmacist collaborative model to improve blood pressure control. Circ Cardiovasc Qual Outcomes. 2015;8(3):235–43.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Morisky DE, Levine DM, Green LW, Shapiro S, Russell RP, Smith CR. Five-year blood pressure control and mortality following health education for hypertensive patients. Am J Public Health. 1983;73:153–62.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    • Chen E, et al. The impact of health coaching on medication adherence in patients with poorly controlled diabetes, hypertension, and/or hyperlipidemia: a randomized controlled trial. J Am Board Fam Med. 2015;28(1):38–45. This study demonstrated that health coaching can help patients gain medical knowledge, skills, and confidence to become active and informed participants in the management of their chronic conditions. CrossRefPubMedGoogle Scholar
  41. 41.
    Meinema JG, van Dijk N, Beune EJAJ, Jaarsma DADC, van Weert HCPM, Haafkens JA. Determinants of adherence to treatment in hypertensive patients of African descent and the role of culturally appropriate education. Zeeb H, ed. PLoS One 2015;10(8):e0133560.Google Scholar
  42. 42.
    Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006;60(6):631–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Schoenthaler A, Ogedegbe G, Allegrante JP. Self-efficacy mediates the relationship between depressive symptoms and medication adherence among hypertensive African Americans. Health Educ Behav. 2009;36(1):127–37.CrossRefPubMedGoogle Scholar
  44. 44.
    Brus H, van de Laar M, Taal E, Rasker J, Wiegman O. Determinants of compliance with medication in patients with rheumatoid arthritis: the importance of self-efficacy expectations. Patient Educ Couns. 1999;36(1):57–64.CrossRefPubMedGoogle Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  • Paola C. Roldan
    • 1
  • Grant Y. Ho
    • 2
  • P. Michael Ho
    • 1
    • 3
    • 4
  1. 1.Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraUSA
  2. 2.Kent Denver SchoolEnglewoodUSA
  3. 3.VA Eastern Colorado Health Care SystemDenverUSA
  4. 4.Division of CardiologyUniversity of Colorado Anschutz Medical CampusAuroraUSA

Personalised recommendations