BMJ 2001;323:142-146 ( 21 July )

Primary care

Relation between insufficient response to antihypertensive treatment and poor compliance with treatment: a prospective case-control study

Reto Nuesch, senior registrar,  Kerstin Schroeder, junior fellow,  Thomas Dieterle, senior fellow,  Benedict Martina, head of medical emergencies,  Edouard Battegay, assistant professor of internal medicine. 

Outpatient Department of Internal Medicine, University Hospital, CH-4031 Basle, Switzerland

Correspondence to: E Battegay ebattegay{at}uhbs.ch

Objectives: To prospectively compare compliance with treatment in patients with hypertension responsive to treatment versus patients with treatment resistant hypertension.
Design: Prospective case-control study.
Setting: Outpatient department in a large city hospital in Switzerland, providing primary, secondary, and tertiary care.
Participants: 110 consecutive medical outpatients with hypertension and taking stable treatment with at least two antihypertensive drugs for at least four weeks.
Main outcome measures: Treatment compliance assessed with MEMS devices; blood pressure determined by 12 hour daytime ambulatory monitoring (pressure <135/85 mm Hg in patients aged 60 years and <155/90 mm Hg in patients aged >60 indicated hypertension responsive to treatment).
Results: Complete data were available for 103 patients, of whom 86 took 80% of their prescribed doses ("compliant") and 17 took <80% ("non-compliant"). Of the 49 patients with treatment resistant hypertension, 40 (82%) were compliant, while 46 (85%) of the 54 patients responsive to treatment were compliant.
Conclusion: Non-compliance with treatment was not more prevalent in patients with treatment resistant hypertension than in treatment responsive patients.

What is already known on this topic For many patients with arterial hypertension, blood pressure cannot be adequately controlled despite treatment with antihypertensive drugs Patients' poor compliance with treatment is often suggested as the reason for lack of response to antihypertensive drugs What this study adds When treatment compliance was monitored in hypertensive patients following stable treatment regimens, no difference in compliance was found between those with treatment resistant hypertension and those responsive to treatment Factors other than patients' compliance with treatment regimens should be examined to explain lack of response to antihypertensive drugs

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Rapid Responses:

Read all Rapid Responses

This is not a case control study

Martin Bland
bmj.com, 24 Jul 2001 [Full text]

Need to acknowledge pharmacological properties of antihypertensive drugs in compliance research

Knut Schroeder
bmj.com, 27 Jul 2001 [Full text]

Blood pressure and adherence monitoring in a hypertensive population: measurement or intervention?

J J Parienti
bmj.com, 28 Jul 2001 [Full text]

Compliance in resistant hypertension

Burnier Michel
bmj.com, 30 Jul 2001 [Full text]

Lack of statistical power

Adam Jacobs
bmj.com, 3 Aug 2001 [Full text]

Sample size

Joyce Cramer
bmj.com, 7 Aug 2001 [Full text]

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