THE IMPLICATIONS OF NONCOMPLIANCE WITH ANTIHYPERTENSIVE MEDICATION

Given the clear evidence that reducing blood pressure decreases the va scular complications of hypertension, loss of efficacy represents the principal complication of noncompliance with antihypertensive therapy. Withdrawal symptoms are also important and occur after abruptly stopp ing beta-blockers and centrally-acting antihypertensive drugs. Very fe w studies have been conducted to assess the impact of missing 1 or 2 d oses of an antihypertensive agent on short term control of blood press ure. A high trough to peak ratio (> 50%) for a once-daily medication s uggests a long duration of action. However, methodological problems in the design of the studies to determine trough to peak ratios make com parisons between various medications very difficult. In general, howev er, stopping a drug with a low trough to peak ratio is more likely to result in loss of antihypertensive effect than a drug with a high rati o. Poor compliance in dose-escalating studies with antihypertensive ag ents may have resulted in excessively high dose recommendations in cli nical trials.