Hypertension

08 March 2017

Only a fifth of patients take all their hypertension meds

A Dutch study found that failure to follow doctors' orders for high blood pressure may lead to unnecessary and costly treatments.

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According to the South African Demographic and Health Survey there are about 3.3 million people with hypertension in the country. Acceptance of the international definition of hypertension (BP ≥140/90 mmHg) adds a further 2.7 million people.

Hypertension is a major and costly contributor to cardiovascular disease: It was previously shown to constitute 7.5% of the direct total healthcare spend in South Africa.

There are many effective blood pressure pills on the market, and it is generally agreed that the majority of patients with high blood pressure can be successfully treated using these medications.

However, only 20% of patients seeking care for stubborn high blood pressure take all the medicine they're supposed to, according to a new Dutch study.

"Another 20% are not taking any of their blood pressure medications," study senior author Dr Peter Blankestijn said in an American Heart Association news release.

Doctor's orders

As a result, patients sought care for a condition they could have addressed by simply following their doctor's orders, the findings suggested.

The study was published in the journal Hypertension.

"People mistakenly thought to have resistant hypertension – which is high blood pressure despite taking three or more medications – end up seeing specialists and undergoing extra tests because we don't understand why they are so difficult to treat," said Blankestijn. He is a professor of nephrology and hypertension at the University Medical Center Utrecht in the Netherlands.

According to a Health24 article, the treatment objectives of hypertension drugs are:

  • To reach blood pressure targets (lower than 140/90 mmHg for people with no major risk factors, co-existing disorders or target organ damage, but 130/80 mmHg for people with major risk factors, diabetes other co-existing disorders, or target organ damage) within three months.
    To limit or prevent additional target organ damage – particularly to the heart, brain, kidneys, blood vessels and eyes. 
  • To achieve blood pressure control with no or minimal side effects. 
  • To decrease the overall cardiovascular risk, not only the blood pressure. 
  • To find a formulation that provides 24-hour efficacy.

A radical treatment

The researchers of the study in Hypertension didn't set out to determine whether people with resistant high blood pressure were following doctors' prescriptions. Instead, the investigators wanted to know if those patients could benefit from a treatment in which nerves between the brain and the kidney are destroyed by radio waves or ultrasound.

The study looked at 95 patients who were randomly assigned to undergo the procedure and 44 who only continued their medications. The researchers concluded the procedure wasn't better than normal treatment for resistant high blood pressure. But following doctors' orders is key, the study authors stressed.

Stay diligent with medication

"Adherence to medication greatly affects the ability to assess the value of another treatment, so researchers need to measure adherence and do what they can to improve it," Blankestijn explained.

Patients must tell their doctor if they don't want to take their medicine for any reason, he added. "You and your doctor can discuss options for changing the type of pill or the dose if needed. There are many effective blood pressure pills and the majority of patients with high blood pressure can be successfully treated," he said.

High blood pressure increases a person's risk of heart attack, stroke and other health issues. And although this study was conducted in the Netherlands, the results likely apply to patients in the United States, according to the researchers. The same would apply to many other countries, including South Africa.

Read More:

Hypertension might affect kids' thinking abilities

Stressed young men have higher risk for future hypertension

'White coat hypertension' may increase heart disease risk

 

Ask the Expert

Hypertension expert

Dr Jacomien de Villiers qualified as a specialist physician at the University of Pretoria in 1995. She worked at various clinics at the Department of Internal Medicine, Steve Biko Hospital, these include General Internal Medicine, Hypertension, Diabetes and Cardiology. She has run a private practice since 2001, as well as a consultant post at the Endocrine Clinic of Steve Biko Hospital.

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