Blood Pressure Control and Reducing Non-Compliance
High blood pressure, or hypertension, is often called the silent killer, because it increases the risk for serious health problems, such as heart attack, stroke, and kidney disease, without signs or symptoms. Uncontrolled hypertension also can lead to cognitive decline and dementia.
The Centers for Disease Control and Prevention wants to end the silence, and a new report of theirs sheds light on a potential healthcare epidemic.
About 70 percent of adults over the age of 65 in the U.S. have high blood pressure, and only about half have their condition under control (defined as blood pressure under 140/90 mmHg). About one in six people with hypertension over 65 are unaware they have the condition, and one in 4 are not receiving treatment.
Treatment for high blood pressure includes lifestyle measures—regular physical activity, maintaining a healthy weight, eating a heart-healthy diet, and restricting alcohol consumption—and, in most cases, daily medication. Treatment is important to reduce the risk for serious, possibly life-threatening, complications. Not following medication instructions—called non-compliance or non-adherence—is a serious problem that can lead to a number of short- and long-term health problems. It’s estimated that non-compliance is associated with about 125,000 deaths, and nearly $300 billion in additional health care costs for doctor and emergency room visits, medical tests, and hospitalizations each year in the United States.
The American Heart Association reports that three out of four Americans do not take their blood pressure medication as directed. According to the CDC, this includes 25 percent of people over the age of 65 with Medicare Part D health insurance—5 million adults—who skip doses or don't fill/re-fill their prescriptions for blood pressure medication. About one-quarter of all prescriptions for blood pressure medication are never filled and another 25 percent of people who start taking blood pressure medication stop taking the drug(s).
Among people with Medicare Part D health insurance, the percentage of people who don't take blood pressure medication as prescribed is higher in certain areas of the United States, including the "stroke belt" in the Southern U.S., as well as in certain race/ethnic populations, such as American Indians/Alaskan natives (39 percent), Blacks (36 percent), and Hispanics (34 percent). According to the CDC, the highest compliance is found in North Dakota, Wisconsin, and Minnesota and in non-Hispanic whites.
There are many possible reasons for non-compliance. Patients may simply forget to take their medicine, may have doubts about whether the drug is working or truly needed, or may experience adverse side effects. For an increasing number of patients, the rising cost of prescription drugs is an important factor.
Good communication among patients, health care providers, pharmacists, and caregivers can help reduce non-compliance. The first step is to make sure the patient understands his or her diagnosis, the goal(s) of treatment, and the purpose of the medication(s).
It's important to understand:
How and when to take your medicine
If you can take your medication with other over-the-counter (OTC) or prescription drugs or diet supplements
Which foods you should avoid while taking the medicine, if any
What to do if you miss a dose
Possible side effects and interactions
Possible serious reactions and what to do if they occur
There are a number of tools available to help patients comply with their medication schedule. These include pill organizers, medication lists, text alerts and reminders, and mobile apps.
Health care providers can help simplify blood pressure treatment for patients by prescribing 90-day refills, combination drugs, and generic medications, if possible. They can encourage patients to use at-home blood pressure monitors, which also may be helpful.