Non-adherence in the hypertensive patient: can nursing play a role in assessing and improving compliance?

According to the Canadian Hypertension Society (Canadian Hypertension Education Program, 2008), hypertension remains a significant health problem that is projected to become a greater global burden in the next 20 years. Internationally, the estimated total number of adults with hypertension in 2000 was 972 million; 333 million in economically developed countries. Current trends suggest that the number of adults with hypertension will increase by about 60% to a total of 1.56 billion by 2025. Despite the availability of effective treatment, more than half of patients treated for hypertension drop out of care entirely within a year of diagnosis. Fifty per cent of patients who remain under medical supervision take only 80% of their prescribed medications. As a result, 75% of patients with a diagnosis of hypertension do not achieve optimum blood pressure control due to poor adherence to anti-hypertensive treatment. Nurses represent a formidable force in improving adherence and care outcomes by understanding the dynamics of compliance, and employing techniques in assessing and monitoring the problems of nonadherence. Nurses are well positioned to effectively use sustained strategies to improve adherence, thereby decreasing the global burden of hypertension. Using a case study approach, this author explores the dynamics of adherence and reviews techniques for assessing, monitoring, and improving compliance in hypertension therapy.