Medication Nonadherence: An Unrecognized Cardiovascular Risk Factor

Mark A. Munger, PharmD; Benjamin W. Van Tassell, PharmD; Joanne LaFleur, PharmD, MSPH

September 19, 2007

Summary

In summary, patient nonadherence is a universal significant risk factor for cardiovascular disease, thereby requiring a comprehensive intervention approach. For many patient populations, dynamic communication between the healthcare team and the patient is a key factor in fostering adherence with long-term medication regimens. Educational programs that inform patients about their disease and the importance of adherence, interdisciplinary approaches to monitoring adherence, and utilization of home-based technologies can also aid in increasing adherence. New therapeutic modalities to treat hypertension with increased efficacy and fewer adverse effects may also contribute to greater adherence.

Authors' Contributions: The outline, writing, and editing of the manuscript were undertaken by the authors in an equal workload distribution.

References

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Cite this: Medication Nonadherence: An Unrecognized Cardiovascular Risk Factor - Medscape - Sep 19, 2007.

Frequently Reported Adverse Effects of Available Antihypertensive Drugs Given as Monotherapy
Class of Drug	Adverse Effects
Angiotensin II receptor blockers	Dizziness, hypotension, hyperkalemia
Angiotensin-converting enzyme inhibitors	Dry cough, hyperkalemia, nausea, vomiting, constipation, rash, headache, dizziness, fatigue
Alpha-blockers	Dizziness, headache, fatigue, nausea, urinary incontinence, postural hypotension
Beta-blockers	Bradycardia, peripheral vasoconstriction, bronchospasm, gastrointestinal disturbances, fatigue, sleep disorders
Central alpha-2 agonists and other centrally acting drugs	Dry mouth, diarrhea, hepatotoxicity, fluid retention, depression, drowsiness, parkinsonism, inability to ejaculate
Calcium channel blockers (dihydropyridines and nondihydropyridines)	Peripheral edema, headache, diarrhea, nausea, flushing, dizziness
Diuretics (thiazide, loop, and potassium-sparing diuretics)	Impotence, decreased libido, lethargy, constipation, nausea, dizziness
Vasodilators	Tachycardia, fluid retention, nausea, vomiting, headache
Aldosterone receptor blockers	Upper respiratory tract infection, headache, nonspecific pain, hyperkalemia

See references 39, 40

Strategies for Improving Adherence With Antihypertensive Drug Therapy
Factor Contributing to Nonadherence	Strategy for Improving Adherence
Adverse effects of drug(s)	Prescribe drug(s) with placebo-like tolerability
Periods of drug withdrawal	Use long-acting drugs that provide 24-hour blood pressure control (or longer)
Multiple-dosing regimen	Simplify the dosing regimen by prescribing a drug with high efficacy that can be taken once daily
Use of concomitant drugs	Prescribe low-dose combination therapy
Inadequate knowledge of drug	Improve patient monitoring Increase patient access to support staff Enhance patient education by scheduling follow-up visits and providing educational literature

See reference 2

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