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Review
. 2010 Jan;12(1):40-6.
doi: 10.1111/j.1751-7176.2009.00200.x.

Compliance with the treatment of hypertension: the potential of combination therapy

Serap Erdine  1
Affiliations
Review

Compliance with the treatment of hypertension: the potential of combination therapy

Serap Erdine. J Clin Hypertens (Greenwich). 2010 Jan.

Abstract

Patient adherence to antihypertensive medication is vital to ensure the successful treatment of hypertension. Low levels of adherence to and persistence with prescribed therapy are major factors leading to the current poor rates of blood pressure control among patients with hypertension. There are many reasons for nonadherence to therapy including patient-, physician-, and therapy-related factors. Poor tolerability has a detrimental effect on adherence, therefore reducing the apparent effectiveness of agents with dose-dependent side effects. Various effective combination therapies are recommended by current guidelines, eg, beta-blocker plus calcium channel blocker (CCB), angiotensin receptor blocker (ARB) plus thiazide diuretic, angiotensin-converting enzyme (ACE) inhibitor plus thiazide diuretic, CCB plus thiazide diuretic, ACE inhibitor plus CCB, and ARB plus CCB, and these have the potential to increase adherence to therapy by combining a favorable tolerability profile with once-daily dosing.

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Figures

Figure 1
Figure 1
 Possible combinations between some classes of antihypertensive drugs. The preferred combinations in the general hypertensive population are represented as thick lines. The frames indicate classes of agents proven to be beneficial in controlled intervention trials. ACE indicates angiotensin‐converting enzyme. Reproduced with permission from Mancia et al.
Figure 2
Figure 2
 Factors specific to the patient, the provider, and the health care system interact to cause poor adherence. Reproduced with permission from Osterberg and Blaschke.
Figure 3
Figure 3
 Patient adherence to antihypertensive therapy over a period of 10 years. Reproduced with permission from van Wijk and coworkers.
Figure 4
Figure 4
 Persistence to antihypertensive drug classes over a 12‐month and 4‐year period. ARBs indicate angiotensin receptor blockers; ACE, angiotensin‐converting enzyme; CCBs, calcium channel blockers. *P<.05 vs ARBs. **P<.01 vs ARBs. Figure reproduced with permission from Conlin et al.
See this image and copyright information in PMC

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