Medication Adherence in Patients with Hypertension: How Pharmacist Outreach Makes a Difference
Any pharmacist can tell you of the fallacy many patients fall prey to: that of mistaking prevention for a cure. That is, when medication or a health regimen makes them asymptomatic, they feel like they no longer need to continue on that regimen anymore. When they’re asymptomatic to begin with, as happens with hypertension, they’re even more likely to stop adhering to their antihypertensive regimen. Lack of adherence is so common that it becomes essential for pharmacists to intervene. When you strive to understand the decision-making variables, you can help boost adherence and make all the difference to your patients’ health.
Current Status of Hypertension in the U.S.
Hypertension is a long-standing and well-defined health concern, but this brief recap illustrates the extent of the problem:1
- One out of every three adults has high blood pressure.
- One out of every three adults has prehypertension.
- High blood pressure is projected to increase by 8 percent between 2013 and 2030
High blood pressure raises the risk of cardiovascular disease and stroke, the two top causes of death. Hypertension alone was the primary or contributing cause of more than 410,000 deaths in 2014. These facts should motivate medication adherence, but they don’t—a good indication that pharmacists need to identify and deal with the issues affecting patient decisions.
The current guidelines published by the American Heart Association identify these diagnostic criteria:
- Normal blood pressure – systolic less than 120 mm Hg – and – diastolic less than 80 mm Hg.
- Prehypertension – systolic of 120 to 139 mm Hg – or – diastolic of 80 to 89 mm Hg.
- Hypertension Stage 1 – systolic of 140 to 159 mm Hg – or – diastolic of 90 to 99 mm Hg.
- Hypertension Stage 2 – systolic of 160 or higher – or – diastolic of 100 or higher.
- Hypertensive crisis – systolic higher than 180 mm Hg – or – diastolic higher than 110.
Adults diagnosed with stroke or cardiovascular disease should keep blood pressure below 140/90 mm Hg.2 A study published in the Journal of the American Medical Association in June 2016 suggests even stricter control of blood pressure in elderly adults. Lowering systolic blood pressure to 120 mm Hg in adults who were 75 or older significantly reduced cardiovascular events and death from any cause.3
Overview of Treatment Options
While medications may be prescribed beginning at stage 1 hypertension, lifestyle modifications are not negotiable for most patients. When you counsel patients filling prescriptions for antihypertensives, be sure to ask whether their physician recommended lifestyle changes. If yes, ask how they’re doing and encourage their efforts. If no, mention that diet, exercise, losing weight and stopping smoking may be enough to get blood pressure under control. Be prepared to recommend the American Heart Association’s “Check. Change. Control.” blood pressure program or any other programs offered by local medical centers.4
Medications are prescribed for about 77 percent of hypertensive patients, usually when lifestyle changes fail to lower blood pressure or when other high-risk conditions are present, such as heart disease, kidney disease, recurrent stroke and diabetes. Thiazide diuretics can be used alone or with any other antihypertensive agents. Certain drug classes are recommended for each comorbid condition:5
- Heart failure – Diuretics, beta-blockers, ACE inhibitors, angiotensin receptor blockers (ARB), aldosterone antagonist
- Post-myocardial infarction – Beta-Blocker, ACE inhibitor, aldosterone antagonist
- High risk of coronary disease – Diuretics, beta-blockers, ACE inhibitors, calcium channel blockers (CCB)
- Diabetes – Diuretics, beta-blockers, ACE inhibitors, ARB, CCB
- Chronic kidney disease – ACE inhibitor, ARB
- Recurrent stroke prevention – Diuretics, ACE inhibitors
Pharmacist Outreach to Promote Medication Adherence
The flowchart approach makes medication compliance seem like a sure bet. Does taking medication lower blood pressure? Yes. Does lowering blood pressure reduce the risk of cardiovascular disease, stroke and death? Yes. Therefore, patients will adhere to their medication regimen. But statistics tell a different story. About half of all patients stop treatment in the first year. By the end of five years, only 10 to 15 percent still stick with the regimen.6 Pharmacists can improve those numbers.
“If you have hypertension, it pays to include a pharmacist in the medical care team,” said Science Daily in their coverage of a 2015 study. This was just one of many studies over the years in which researchers concluded that pharmacist intervention resulted in better control of blood pressure. Of the outcomes reported, improved blood pressure was obviously the most important, but two others are worth noting:7
- When pharmacists were on the team, medication dose was adjusted about 5 times during a nine-month period. By comparison, meds were adjusted once in patients who only saw a physician.
- More time was spent educating patients about how to lower blood pressure when pharmacists were involved.
It’s not hard to uncover the reasons why a patient stops taking their antihypertensive meds. Remember that no matter how irrational their decision seems, their reasons are always important. Ask about these categories:
- Lack of symptoms – The lack of symptoms makes patients believe they’re fine and don’t need meds, especially if no one has talked with them about blood pressure basics.
- Education – Non-adherence often occurs when patients don’t understand the cause, symptoms or risks of hypertension. Ask patients about their perceptions, teach about the impact of hypertension on their blood vessels and how it leads to heart disease, stroke and death. Talk about the role of medication and discuss side effects.
- Cost of medication – Patients may not be able to afford their medication. You can bring up the topic by first asking to verify insurance coverage, then mentioning payment assistance or other programs available.
- Poor results – Patients may get discouraged and stop taking meds if they don’t see results. Check your records to see whether their dose has been adjusted and speak with the doctor about the possibility of changing the dose or type of medication.
- Treatment complexity – If patients take multiple meds, they may need help keeping track of their medication schedule. Adherence aids like a pill box may be all they need. Otherwise try adjusting the timing, frequency or dose so that they can take all meds at one time.
Collaboration with the Medical Team Benefits Hypertensive Patients
As you reach out to patients, it’s also important to develop relationships with their physicians. Tell them about your hypertension-related services, whether that’s medication management, education about high blood pressure, or you have a digital monitor and offer free blood pressure screening. Make a plan for communicating with health care providers about their patient’s blood pressure status. The team approach supported by pharmacist involvement increases the chance that your patient will stay on their meds and keep the blood pressure under control.
Pharmaceutica North America provides high-quality bulk APIs, prescription products and OTC supplements to treat multiple aspects of hypertension. Call us today to talk about our products and how we can help support all of the patients that rely on your pharmacy for safe and effective treatments.
- “High Blood Pressure Fact Sheet,” June 2016, http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm ↩
- “Hypertension: New Treatment Guidelines,” December 2015, http://www.pharmacytimes.com/publications/issue/2015/december2015/hypertension-new-treatment-guidelines ↩
- “Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged 75 Years and Older,” June 2016, http://jama.jamanetwork.com/article.aspx?articleid=2524266 ↩
- “Check. Change. Control. Blood Pressure Program,” 2016, http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/HighBloodPressureToolsResources/Check-Change-iControli-153—Blood-Pressure-Program_UCM_449318_Article.jsp#.V31scfkrLIV ↩
- “Hypertension Treatment and Management,” September 2014, http://emedicine.medscape.com/article/241381-treatment ↩
- “Measuring, Analyzing, and Managing Drug Adherence in Resistant Hypertension,” June 2013, http://hyper.ahajournals.org/content/62/2/218.full ↩
- “Pharmacists Help Patients with Hypertension,” July 2015, https://www.sciencedaily.com/releases/2015/07/150730111041.htm ↩