Consequences of intermittent treatment for hypertension: The case for medication compliance and persistence

Objective: To review patient compliance with once-daily antihypertensive me dications and the impact of partial compliance on healthcare outcomes. Data Sources: A MEDLINE search of the literature using the terms "patient c ompliance," "antihypertensive medications," and "hypertension" for the peri od 1976-1996 was conducted. In addition, papers cited in reference lists of source articles were reviewed. Study Selection: Articles were selected if they described patterns of compl iance, including rates for differing dosing regimens. Articles discussing o nce-daily dosing were selected only if they included information on the met hodology for compliance assessment. Thirteen reports met these criteria, Data Synthesis: Patterns of compliance vary, with only a partial relationsh ip to dosing regimens. Overall compliance was 76% for once-daily antihypert ensive medications, with a wide range found (53% to 85%). These data were c omparable to the mean 75% compliance found for other medical disorders. Conclusions: Persistence with treatment is necessary for reduction of long- term consequences of hypertension. Enhancing compliance with antihypertensi ve medications could thus have a profound impact on health outcomes. Once-d aily dosing should be coupled with selection of a drug with long duration o f action to overcome problems of missed doses. Widespread adoption of simpl e compliance enhancement methods could lead to decreased morbidity and mort ality from cardiovascular disease and stroke.