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Adherence Therapy Helps Reduce Hypertension! A person is said to have hypertension, or more commonly known as high blood pressure, when his or her blood pressure (systolic/diastolic) reaches 140/90 mm Hg. Persistent hypertension can be a risk factor for heart disease and stroke, and it can also lead to other diseases like kidney failure. Hypertension affects about 25 percent of the adult, including 10 million people in the United Kingdom, and it costs more than $300 billion every year. Health experts believe hypertension is likely to increase dramatically over the next 15 years. Many factors could affect one’s blood pressure. These include amount of water and salt in the body, condition of kidney, nervous system or blood vessels, and the levels of different body hormones. A person is likely to have hypertension if he or she is obese, often stressed or anxious, eats too much salt, has a family history of high blood pressure, is diabetic or smokes. Lowering of blood pressure can lead to reductions in the incidence of stroke and cardiovascular heart disease. Therefore, patients with high blood pressure are usually prescribed with medications that are intended to bring their blood pressure to the desired healthy range.
According to a study conducted by researchers from the University of East Anglia (UEA), a high proportion of hypertensive patients failed to take their medications properly, but these patients would benefit clinically from a course of 'adherence therapy'. Their findings were published on February 16, 2011 in the ‘Journal of Human Hypertension’. About half of hypertensive patients do not take their prescribed medications correctly and hence fail to reduce their blood pressure to less than 140/90 mm Hg. Some stop taking all their medications while others only take some of it. Many of the patients simply do not follow the instructions to take their medicine, for instance, after food. The rationale behind such non-adherence is complex. Concern over the side effect, beliefs about illness and treatment, and complexity of treatment regimes are some of the possible reasons. Doctors used to improve adherence with the help of information leaflets, monthly outpatient visits, reminders and self-monitoring. Nevertheless, most of these measures have been shown to be ineffective. In the study, researchers examined 136 patients with hypertension in 3 outpatient clinics in Jordan. Half of them were given a course of 7-week adherence therapy sessions and the other half continued with their usual treatment. A trained clinician was assigned to conduct a 20-minute face-to-face session to provide tailored information about the illness and treatment and to explore each patient’s own beliefs, fears and lifestyle. The results showed that patients who were given adherence therapy took 97 percent of their medications, compared with only 71 percent for those given treatment as usual. Moreover, their blood pressure, on average, was reduced by around 14 percent to a level just above the healthy range. Adherence means how closely a patient, under limited supervision, follows a prescribed treatment regimen, and includes this person’s willingness to start treatment and his or her ability to take medications exactly as advised. Adherence therapy was originally developed by Prof Richard Gray of UEA's School of Nursing and Midwifery for patients with mental health problems failing to take their medications correctly. Total cost of delivering a course of 7 weekly sessions in the study was calculated to be about £80 per person. Other studies have shown that a long-term reduction of blood pressure would lead to a cut in stroke of 56 percent and a reduction in heart disease of 37 percent. Hence, adherence therapy would be a cost-effective intervention even though this particular study was not intended to evaluate cost effectiveness. Besides taking medicines, patients can do many other things to help manage their blood pressure. These include eating a heart-healthy diet, exercising regularly, staying away from cigarettes, limiting alcohol intake, controlling salt intake, reducing stress and maintaining a healthy body weight.
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