Hypertension
Elizabeth Briand
Individuals with hypertension have a range of medications available to them that can treat their conditions and preserve their long-term health. The benefits of those medications are irrelevant, though, if a patient simply does not take them.
Medication adherence is the subject of a new study, published in the July 2025 issue of Journal of Hypertension, that examined the multitude of reasons patients may abandon their antihypertensive drug regimens. Research showed that the reasons behind the lack of adherence are broad, varied, and unique to each patient’s medical and personal situation.
According to the study findings, one of the most significant factors in determining drug adherence was simply the type of medication prescribed. b-blockers and potassium-sparing diuretics—in particular, carvedilol, bisoprolol and spironolactone—had the highest rates of adherence, while ACE inhibitors such as ramipril had the lowest.
b-blockers and potassium-sparing diuretics, according to lead author Nicolas F. Renna, MD, PhD, “are often well tolerated, dosed once daily and prescribed in specific clinical contexts such as heart failure, where patients may perceive greater benefit.”
Lower adherence with ACE inhibitors is likely due to adverse effects such as dry cough, and in some cases, the need for twice-daily dosing, according to Renna, who is with Hospital Espanol de Mendoza in Argentina. “This reinforces the importance of tailoring therapy not only to blood pressure targets but also to adherence potential,” he said.
Addressing other key causes
The research team collected data between 2022 and 2024 for 1,144 men and women with hypertension with a mean age of 58.2 years. A quarter of the patients were smokers, and 41% were patients with obesity. All patients had been diagnosed with hypertension and had been undergoing pharmacological treatment for at least 1 year.
The study findings also showed that more patients stuck to fixed dose combinations compared to taking multiple pills to treat hypertension.
“Simplifying treatment into fewer pills makes it easier for patients to maintain consistency, especially in those with busy lifestyles or multiple comorbidities,” said Renna. “From a behavioral standpoint, fewer daily decisions are required [with fixed dose combinations], which reduces forgetfulness.”
He added that patients on fixed dose combinations may also experience faster clinical benefits, reinforcing their motivation to stay adherent.
Sociological factors such as education and home ownership also appeared to play a significant role in whether a patient maintained their drug regimen. Patients who went beyond high school were 20% more likely to adhere to their treatment compared to those with only a primary education, according to the findings.
“This may be due to better health literacy, understanding of long-term cardiovascular risk, and engagement with preventive care,” said Renna.
In addition, patients who owned their homes, which Renna noted is a proxy for economic stability, were 15% more likely to stay on their medications.
“These factors reflect not only access, but also capacity to prioritize long-term health,” he said. “Patients with stable socioeconomic backgrounds may experience fewer barriers to purchasing medications and attending follow ups.”
Patients with comorbidities such as dementia and individuals who had previously experienced a stroke or myocardial infarction also had a more difficult time staying on their medications.
“This suggests that it’s not just the number of medications, but also the complexity and psychological burden of chronic illness that challenges adherence,” said Renna.
Making adherence easier
To achieve better rates of adherence, Renna encourages prescribers to “aim for a balance between efficacy, simplicity, and tolerability” and consider the patient’s perspective, which can include past experiences with medications, perceived benefits, and barriers to access.
“[Pharmacists] play a central and often underutilized role in supporting treatment adherence,” said Renna. Their accessibility, frequent contact with patients, and pharmacological expertise position them to do everything from identifying over-complex regimens to looking for refill patterns that could signal a patient is neglecting their medications, according to Renna.
Pharmacists also can promote health literacy through patient education and counseling and simply remind patients during routine interactions how important their medications are to maintaining their health and well-being.
“Ultimately, empowering pharmacists through collaborative practice agreements, adherence monitoring protocols, and greater involvement in hypertension management could be transformative,” said Renna. “They are uniquely positioned to help close the gap between prescription and effective, sustained treatment.” ■