Integrated approaches to management of hypertension: Promoting treatment acceptance

Overwhelming trial evidence indicates that the treatment of hypertension is beneficial, but in practice, less than 50% of treated hypertensive subject s have blood pressure well controlled. The success of treatment relies on a cceptance by the patient. Treatment acceptance may be affected by the effic acy and tolerability of drug therapy, its effects on quality of life, and o ther important but less well-recognized influences such as the expectations and preconceived ideas of the physician and the patient. This report brief ly reviews the factors affecting patient concordance with antihypertensive treatment and the role these Factors play in the development of an integrat ed treatment plan. Nonconcordance with drug therapy is common: Only one thi rd of patients always lake treatment, one third take it sometimes, and one third never take their prescribed medication. With poor concordance, contro l of blood pressure and the consequent benefits are less likely to be reali zed. The factors that influence concordance are ill understood. Although dr ug side effects and convenience of dosing regimens are contributors, the at titudes of patients, physicians, and their interactions are likely to be of considerable importance. Concordance may be improved by involving the pati ent in the treatment plan, setting explicit targets, following a clear trea tment pion, motivating the patient to comply with treatment, paying attenti on to the concerns and particular needs of the individual patient, and by e nsuring frequent contacts between patients and health care professions. Suc cessful integrated approaches to the management of hypertension must addres s all the factors that affect treatment acceptance.