Integrated approaches to management of hypertension: Promoting treatment acceptance☆,☆☆,★
Section snippets
Efficacy, side effects, and quality of life during treatment of hypertension
Most antihypertensive agents have similar, modest efficacy.7, 8 Although the response to treatment varies between patients, monotherapy is insufficient in the majority. Some form of combination treatment is necessary in most patients to achieve target blood pressure, but most physicians appear reluctant to use more than one drug. The recent HOT study demonstrated that diastolic blood pressure could be reduced to below 90 mm Hg in almost 90% of patients and to below 80 mm Hg in nearly 60% of
Compliance and concordance
Used in combination, antihypertensive drugs can achieve target blood pressure in the vast majority of patients.13 Side effects are not prominent and, if drug treatment is used effectively to lower blood pressure to near normotensive levels, quality of life may ultimately improve. Despite the evidence of good tolerability in the clinical trial setting, in practice, there appears to be a belief among physicians and patients that antihypertensive medication, particularly in combination, causes an
Improving treatment concordance
In a survey of 843 general practitioners in the United Kingdom, the major reason for noncompliance was thought to be the occurrence of side effects, apathy, and failure to understand risk and treatment (Table I).
Empty Cell Patients (%) Failure to understand risk 32 Apathy 30 Side effects 15 Failure to understand treatment 15 Loss of prescription 8
Conclusion
In conclusion, the management of hypertension is not as simple as was once thought. Hypertension is easily diagnosed, and a range of antihypertensive drugs are available. However, the success of treatment depends on whether the treatment is well accepted by the patient and taken as intended in the long term. Acceptance or nonacceptance may be affected by the efficacy and tolerability of the drug, its effects on quality of life, and other influences such as the expectations and preconceived
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From the Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary.
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Reprint requests: G. McInnes, MD, Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, Scotland, UK. E-mail: [email protected]
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