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Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Medication Nonadherence in Hypertensive Patients

Circ Cardiovasc Qual Outcomes; ePub 2017 Aug 22; Schoenthaler, et al

In hypertensive patients, the odds of poor medication adherence are greater when patient-provider interactions are low in patient centeredness and do not address patients’ sociodemographic circumstances or their medication regimen, a recent study found. The cohort study included 93 hypertensive patients and 27 providers in 3 safety-net primary care practices in New York City and evaluated the impact of patient-provider communication on medication adherence among a sample of primary care providers and their black and white hypertensive patients. Researchers found:

  • 58% of patients exhibited poor medication adherence to prescribed antihypertensive medications.
  • Key features of patient-provider communication that were associated with poor medication adherence included lower patient centeredness (OR, 3.08), less discussion about their socioeconomic circumstances (OR, 6.03), and about their antihypertensive medications (OR, 6.48).
  • Discussion about patients’ social circumstances was an even stronger predictor of medication adherence among black patients.


Schoenthaler A, Knafl GJ, Fiscella K, Ogedegbe G. Addressing the social needs of hypertensive patients. The role of patient-provider communication as a predictor of medication adherence. [Published online ahead of print August 22, 2017]. Circ Cardiovasc Qual Outcomes. doi:10.1161/CIRCOUTCOMES.117.003659.


Adherence is the final frontier. In 2003, the World Health Organization declared that increasing medication adherence could have a greater impact on population health than further advances in medical treatments.1 Adherence rates for most chronic diseases including diabetes, hypertension, and hyperlipidemia range from 50%-80%. When patients don’t take their medications, the potential benefits of them are compromised. Currently quoted adherence rates likely overestimate adherence since much of the data are obtained from pharmacy refill rates and patients may not fully take all their prescriptions that are refilled. It is heartening to see from this study that there are things that we can all do in the office to improve adherence, and that those things are not extraordinary measures—such as talking to patients about their lives, their social and economic circumstances, and their medications. —Neil Skolnik, MD

  1. Sabaté E. Adherence to long-term therapies: Evidence for action. Geneva, Switzerland, World Health Organization, 2003.