Optimizing medication adherence in older persons with hypertension

Suboptimal control of hypertension in largecommunities can be attributed, in part, toabout 50% of patients who stop taking theirantihypertensive drugs after 1 year. Older patientswith many illnesses (including chronic kidneydisease) are at especially high risk for discontinuingprescribed medications, but age is a weaker predictor than the number of consumed pills.Determining if medications are being taken asprescribed is difficult, but asking the patientand significant other the simple question,``Have you missed any pills in the last week?''is a good place to start. Despite all theirother virtues, clinical trials seldom providethe same answers regarding medication adherencethat are found in clinical practice.Observational and a few interventional trialshave established that short, simple regimensthat improve patients' symptoms and arewell tolerated are more likely to be takencorrectly. Patient (and family) education isthe cornerstone of improving adherence tomedication, but several other interventionshave also proven useful. There appears to be no``magic bullet'' that will improve medicationadherence in all patients, but providingwritten instructions, simplifying themedication regimen to as few as necessary,once daily, well tolerated and inexpensivepills, involving family members, and promptingpill taking by certain activities of dailyliving all seem to help. Improving medicationadherence would be a simple way to makeantihypertensive therapies much morecost effective, since a medication that is nottaken incurs all of cost, and provides nobenefit to the patient.