ASH Position Paper: Adherence and Persistence With Taking Medication to Control High Blood Pressure

Authors

  • Martha N. Hill RN, PhD,

    1. From the Johns Hopkins University School of Nursing, Baltimore, MD ; 1the Stanford Cardiac Rehabilitation Program, Stanford University School of Medicine, Palo Alto, CA ; 2 and the Institute of Nursing Science, University of Basel, Basel, Switzerland3
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  • 1 Nancy H. Miller RN, BSN,

    1. From the Johns Hopkins University School of Nursing, Baltimore, MD ; 1the Stanford Cardiac Rehabilitation Program, Stanford University School of Medicine, Palo Alto, CA ; 2 and the Institute of Nursing Science, University of Basel, Basel, Switzerland3
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  • 2 Sabina DeGeest RN, PhD,

    1. From the Johns Hopkins University School of Nursing, Baltimore, MD ; 1the Stanford Cardiac Rehabilitation Program, Stanford University School of Medicine, Palo Alto, CA ; 2 and the Institute of Nursing Science, University of Basel, Basel, Switzerland3
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  • and 3 on Behalf of the American Society of Hypertension Writing Group

    1. From the Johns Hopkins University School of Nursing, Baltimore, MD ; 1the Stanford Cardiac Rehabilitation Program, Stanford University School of Medicine, Palo Alto, CA ; 2 and the Institute of Nursing Science, University of Basel, Basel, Switzerland3
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Martha N. Hill, RN, PhD, Dean of Nursing, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Room 501, Baltimore, MD 21205
E-mail: mnhill@son.jhmi.edu

Abstract

J Clin Hypertens (Greenwich). 2010;12:757-764. © 2010 Wiley Periodicals, Inc.

Nonadherence and poor or no persistence in taking antihypertensive medications results in uncontrolled high blood pressure, poor clinical outcomes, and preventable health care costs. Factors associated with nonadherence are multilevel and relate not only to the patient, but also to the provider, health care system, health care organization, and community. National guideline committees have called for more aggressive approaches to implement strategies known to improve adherence and technologies known to enable changes at the systems level, including improved communication among providers and patients. Improvements in adherence and persistence are likely to be achieved by supporting patient self-management, a team approach to patient care, technology-supported office practice systems, better methods to measure adherence, and less clinical inertia. Integrating high blood pressure control into health care policies that emphasize and improve prevention and management of chronic illness remains a challenge. Four strategies are proposed: focusing on clinical outcomes; empowering informed, activated patients; developing prepared proactive practice teams; and advocating for health care policy reform. With hypertension remaining the most common reason for office visits, the time is now.

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