Improving outcomes in hypertensive patients: focus on adherence and persistence with antihypertensive therapy.

Although effective control of blood pressure (BP) reduces the risk of cardiovascular events in patients with hypertension, BP control rates among treated patients in actual clinical practice are less than optimal. Although the costs of medicines and medical care (which are difficult to estimate both in clinical trials and general clinical practice) are important, medication-taking behavior--adherence and persistence with antihypertensive regimens--influences BP control rates. Many factors affect adherence and persistence with medications, including efficacy and tolerability of drugs prescribed, such that rates vary greatly among antihypertensive classes. In general, medications with fewer adverse effects (in registration trials or large outcomes studies) are associated with increased adherence and lower discontinuation rates. More widespread use of such agents, particularly those available in generic formulations or in low-cost formularies, may lead to better long-term BP control and fewer cardiovascular events.