Pharmacy World and Science

, Volume 23, Issue 2, pp 60–64 | Cite as

Patient‐perceived problems, compliance, and the outcome of hypertension treatment

  • Hannes Enlund
  • Erkki Jokisalo
  • Sirpa Wallenius
  • Maarit Korhonen


Objective: To study the associations between the outcome of antihypertensive therapy with both patient-perceived problems and patient initiated modification of dosage instructions. Design and methods: In this cross-sectional survey, all chronic hypertensives aged less than 75 years (n = 971) visiting nine Finnish pharmacies between May and September of 1996 were asked to participate. Of the 866 agreeing to participate, 482 returned the questionnaire (56%). After excluding persons with missing data, the final study population consisted of 428 hypertensive patients. Information on problems with treatment, the modification of dosage instructions, and blood pressure levels was based on patient self-reports.Results: Two-thirds (68%) of the study population reported suffering from one or more problems. The most common problems were symptoms of high blood pressure and adverse drug effects. Thirty-one percent of the male respondents and 21% of the female respondents reported having modified their dosage instructions. Only 36% of the patients had reached the goal blood pressure (<160/90 mmHg). Patients having problems with hypertension treatment were significantly more likely to have modified their dosage instructions than those without problems (3+ problems, adjusted OR=4.8). Not reaching goal blood pressure levels was sigfinicantly associated with both high number of patient-perceived problems (3+ problems, adjusted OR=2.1) and modification of dosage instructions (adjusted OR=1.9).Conclusion: The poor outcome in antihypertensive therapy is associated with both patient-perceived problems and patient initiated modification of dosage instructions.

Hypertension Patient compliance Patient‐perceived problems Treatment outcome 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hershey JC, Morton BG, Davis JB, Reichgott MJ. Patient compliance with antihypertensive medication. Am J Public Health 1980;70:1081-9.Google Scholar
  2. 2.
    Fujii J, Seki A. Compliance and compliance-improving strategies in hypertension: the Japanese experience. J Hypertens 1985;3(Suppl 1):19-22.Google Scholar
  3. 3.
    Bohnstedt M, Leonard AR, Trudeau MJ, Bal DG. Hypertension-unexpected research results and program redirection. Am J Prev Med 1987;3:200-5.Google Scholar
  4. 4.
    Richardson MA, Simons-Morton B, Annegers JF. Effect of perceived barriers on compliance with antihypertensive medication. Health Educ Q 1993;20:489-503.Google Scholar
  5. 5.
    Silas JH, Tucker GT, Smith AJ. Drug resistance, inappropriate dosing and non-compliance in hypertensive patients. Br J Clin Pharmacol 1980;9:427-30.Google Scholar
  6. 6.
    Dimsdale JE. Reflections on the impact of antihypertensive medications on mood, sedation and neuropsychologic functioning. Arch Intern Med 1992;152:35-9.Google Scholar
  7. 7.
    Wallenius SH, Vainio KK, Korhonen MJH, Hartzema AG, Enlund HK. Self-initiated modification of hypertension treatment in response to perceived problems. Ann Pharmacother 1995;29:1213-7.Google Scholar
  8. 8.
    Khalil SA, Elzubier AG. Drug compliance among hypertensive patients in Tabuk, Saudi Arabia. J Hypertens 1997; 15: 561-5.Google Scholar
  9. 9.
    Enlund H. Measuring patient compliance in antihypertensive therapy-some methodological aspects. J Clin Hosp Pharm 1982;7:43-51.Google Scholar
  10. 10.
    Sever P, Beevers G, Bulpitt C, Lever A, Ramsay L, Reid J, Swales J. Management guidelines in essential hypertension: report of the second working party of the British Hypertension Society. BMJ 1993;306;983-7.Google Scholar
  11. 11.
    Kumpusalo E, Pärnänen H, Takala J. Treatment situation of hypertensive patients in Finnish primary health care. Blood Press 1997;6(Suppl 1):35-9.Google Scholar
  12. 12.
    Kastarinen MJ, Salomaa VV, Vartiainen EA, Jousilahti PJ, Tuomilehto JO, Puska PM, Nissinen AM. Trends in blood pressure levels and control of hypertension in Finland from 1982 to 1997. J Hypertens 1998;16:1379-87.Google Scholar
  13. 13.
    The sixth report of the Joint National Commitee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997;157:2413-46.Google Scholar
  14. 14.
    McCombs JS, Nichol MB, Newman CM, Sclar DA. The costs of interrupting antihypertensive drug therapy in a Medicaid population. Med Care 1994;32:214-26.Google Scholar
  15. 15.
    National Agency for Medicines and the Social Insurance Institution. Finnish Statistics on Medicines 1996. Helsinki 1997.Google Scholar
  16. 16.
    Shaw E, Anderson JG, Maloney M, Jay SJ, Fagan D. Factors associated with noncompliance of patients taking antihypertensive medications. Hosp Pharm 1995; 30:201-3,206-7.Google Scholar
  17. 17.
    Lahdensuo A, Haahtela T, Herrala J, Kava T, Kiviranta K, Kuusisto P, Perämäki E, Poussa T, Saarelainen S, Svahn T. Randomised comparison of guided self management and traditional treatment of asthma over one year. BMJ 1996;312:748-52.Google Scholar
  18. 18.
    Stockwell Morris L, Schulz RM. Patient compliance-an overview. J Clin Pharm Ther 1992;17:283-95.Google Scholar
  19. 19.
    Rudd P. Clinicians and patients with hypertension: Unsettled issues about compliance. Am Heart J 1995;130:572-9. 64 Pharmacy World & Science Volume 23 No. 2 2001Google Scholar

Copyright information

© Kluwer Academic Publishers 2001

Authors and Affiliations

  • Hannes Enlund
    • 1
  • Erkki Jokisalo
    • 2
  • Sirpa Wallenius
    • 2
  • Maarit Korhonen
    • 2
  1. 1.Department of Pharmacy Practice, Faculty of PharmacyKuwait UniversityKuwait
  2. 2.Department of Social PharmacyUniversity of KuopioFinland

Personalised recommendations