The Impact of Antihypertensive Drugs on Adherence

  • Ian M. KronishEmail author
  • Nathalie Moise
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)


There are significant differences in the properties of individual antihypertensive medications in terms of side effects, costs, and dosing complexity among other factors. Accordingly, there are differences in how individual antihypertensive medications impact medication adherence. In this chapter, we review the literature establishing an association between antihypertensive drug class and medication adherence, with adherence typically highest for angiotensin converting enzyme inhibitors and angiotensin receptor blockers and lowest for diuretics and beta-blockers. We also review the mechanisms through which properties of the principal classes of antihypertensive drugs can influence medication adherence. There is also evidence of substantial differences in how antihypertensive medications affect individual patients, with some medications resulting in greater blood pressure reduction and others in lower tolerability. We discuss how this heterogeneity of treatment effect may lead to differential impacts of antihypertensive drugs on medication adherence among individual patients. We conclude by suggesting approaches to preventing adverse effects of antihypertensive drugs on medication adherence in clinical practice. From a clinician’s perspective, we emphasize personalized, patient-centered approaches, including N-of-1 trials, for optimizing the selection and maintenance of medications with the best opportunity for long-term adherence.


Antihypertensives Medication adherence Side effects Drug class Physician communication N-of-1 



Conflicts of Interest: None.


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Center for Behavioral Cardiovascular Health, Columbia University Medical CenterNew YorkUSA

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