Julian E Mariampillai1, Per Anders Eskås1, Sondre Heimark1, Anne Cecilie K Larstorp2,3, Fadl Elmula M Fadl Elmula1,3,4,5, Aud Høieggen1,3,6, Per Nortvedt1,7. 1. a Faculty of Medicine , University of Oslo , Oslo , Norway. 2. b Department of Medical Biochemistry , Oslo University Hospital, Ullevaal , Oslo , Norway. 3. c Section of Cardiovascular and Renal Research , Oslo University Hospital, Ullevaal , Oslo , Norway. 4. d Department of Cardiology , Oslo University Hospital, Ullevaal , Oslo , Norway. 5. e Department of Internal Medicine , Oslo University Hospital, Ullevaal , Oslo , Norway. 6. f Department of Nephrology , Oslo University Hospital, Ullevaal , Oslo , Norway. 7. g Center for Medical Ethics, University of Oslo , Oslo , Norway.
Abstract
BACKGROUND: Poor drug adherence is a major cause of apparent treatment-resistant hypertension. As a consequence, several methods have been developed and attempted implemented in clinical practice to reveal non-adherence and to monitor drug adherence. There are, however, several hitherto unresolved ethical aspects regarding potential methods for drug monitoring in these patients. RESULTS: The most striking challenge is the balance between patient autonomy and the physician's desire for the patient to adhere to the prescribed therapy. Also, methods for monitoring must only be implemented in the treatment of well-informed and consenting patients. Major resources are used on non-adherent patients; how long the physician should encourage continuation of treatment is an important question. CONCLUSIONS: We believe that physicians should reflect and discuss these potential challenges, and that patient education, information and a solid patient-physician relationship are essential for achieving drug adherence. Methods for monitoring adherence represent, however, a useful and often necessary supplement.
BACKGROUND: Poor drug adherence is a major cause of apparent treatment-resistant hypertension. As a consequence, several methods have been developed and attempted implemented in clinical practice to reveal non-adherence and to monitor drug adherence. There are, however, several hitherto unresolved ethical aspects regarding potential methods for drug monitoring in these patients. RESULTS: The most striking challenge is the balance between patient autonomy and the physician's desire for the patient to adhere to the prescribed therapy. Also, methods for monitoring must only be implemented in the treatment of well-informed and consenting patients. Major resources are used on non-adherent patients; how long the physician should encourage continuation of treatment is an important question. CONCLUSIONS: We believe that physicians should reflect and discuss these potential challenges, and that patient education, information and a solid patient-physician relationship are essential for achieving drug adherence. Methods for monitoring adherence represent, however, a useful and often necessary supplement.
Entities:
Keywords:
Ethical aspects; blood pressure-lowering treatment; drug adherence; treatment-resistant hypertension
Authors: Saskia E van Grondelle; Sytske van Bruggen; Judith Meijer; Erik van Duin; Michiel L Bots; Guy Rutten; Hedwig M M Vos; Mattijs E Numans; Rimke C Vos Journal: BMJ Open Date: 2022-07-08 Impact factor: 3.006