Patient Adherence to Antihypertensive Therapy: Barriers and Solutions

Nguyen Lima^*
*Correspondence: Nguyen Lima, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy, Email:

Introduction

Despite substantial advances in the pharmacologic management of hypertension, non-adherence to antihypertensive therapy remains one of the primary barriers to achieving optimal blood pressure control. It is estimated that up to 50% of patients discontinue their medications within the first year of treatment, contributing to preventable cardiovascular events, hospitalizations and increased healthcare costs. Adherence is influenced by a complex interplay of patient-related, therapy-related, healthcare system and socioeconomic factors. Understanding these barriers is critical to designing effective interventions that improve long-term medication-taking behavior and health outcomes. This article discusses the major barriers to antihypertensive adherence and outlines evidence-based strategies and system-level solutions to promote sustainable adherence across diverse patient populations [1].

Description

Patient-level factors are among the most significant contributors to non-adherence. These include lack of understanding about hypertension, the asymptomatic nature of the disease, forgetfulness, fear of side effects and cultural beliefs about medication use. Many patients discontinue medications once they feel better or wrongly believe that antihypertensive drugs are only required temporarily. Psychological factors, such as depression, anxiety and low health literacy, can also interfere with consistent medication use. Furthermore, the complexity of comorbid conditions such as diabetes, chronic kidney disease, or dyslipidemia can lead to â??pill fatigueâ? or confusion regarding treatment regimens. Social isolation, lack of family support and mistrust in healthcare providers further reduce engagement. Empowering patients through health education, addressing fears and misconceptions and promoting shared decision-making can enhance the perceived value of therapy and foster better adherence. Involving family members or caregivers in counseling may also create a support network that encourages regular treatment adherence [2].

Medication-related factors such as polypharmacy, pill burden, adverse drug reactions and dosing frequency play a major role in adherence behaviors. Patients on multiple medications or those required to take drugs more than once daily are less likely to maintain consistent usage. Some antihypertensive agents may cause bothersome side effects such as fatigue, dizziness, sexual dysfunction, or frequent urination that deter patients from long-term compliance. Additionally, abrupt initiation of multiple medications without adequate explanation may result in confusion or perceived harm. Simplifying regimens through fixed-dose combination (FDC) therapy, once-daily dosing and stepwise titration strategies can significantly improve adherence. FDCs not only reduce pill burden but also enhance BP control and patient satisfaction. Physicians must tailor treatment plans based on individual risk profiles, tolerability and patient preferences, while regularly monitoring for adverse effects and ensuring patients understand the goals of therapy and expected outcomes [3].

Systemic obstacles such as inadequate follow-up, fragmented care, inconsistent counseling and limited patient-provider interaction can weaken adherence. In many healthcare settings, especially in low-resource or high-volume clinics, time constraints prevent comprehensive adherence counseling. Some providers may overlook non-adherence, misinterpreting uncontrolled blood pressure as treatment resistance. Moreover, limited access to medications, high out-of-pocket costs and inconsistent pharmacy supply chains further undermine adherence, particularly in marginalized populations. Health systems must prioritize adherence support through integrated care models, patient navigators and interdisciplinary teams. Utilizing electronic health records (EHRs) to flag non-adherent patients, issuing automated reminders and ensuring continuity of care across providers are practical strategies. Training clinicians to ask open-ended questions, provide motivational interviewing and routinely assess adherence using validated tools can foster more effective communication and tailored interventions. Creating patient-friendly environments that value accessibility, affordability and personalized care is crucial to overcoming systemic barriers [4-5].

Conclusion

Mobile health (mHealth) tools such as SMS reminders, smartphone apps and Bluetooth-enabled pillboxes have been shown to improve adherence in various populations by offering real-time prompts, feedback and data tracking. Behavioral economics principles, including nudging, incentives and loss aversion, can be used to design adherence programs that align with patient motivations. Community pharmacists and health workers play an essential role in providing medication counseling, home visits and personalized follow-up in both rural and urban settings. Importantly, adherence interventions must be culturally tailored and patient-centered, considering language, literacy, beliefs and health access to ensure meaningful and sustainable impact.

Acknowledgement

None.

Conflict of Interest

None.

References

1. DiMatteo, M. Robin. "Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research." Med Care42 (2004): 200-209.

Google Scholar Cross Ref Indexed at

2. Naderi, Sayed H., Jonathan P. Bestwick and David S. Wald. "Adherence to drugs that prevent cardiovascular disease: Meta-analysis on 376,162 patients."  Am J Med 125 (2012): 882-887.

Google Scholar Cross Ref Indexed at

3. Ogedegbe, Gbenga, Antoinette Schoenthaler, Tabia Richardson and Lisa Lewis, et al. "An RCT of the effect of motivational interviewing on medication adherence in hypertensive African Americans: Rationale and design." Contemp Clin Trials28 (2007): 169-181.

Google Scholar Cross Ref Indexed at

4. Nafradi, Lilla, Elisa Galimberti, Kent Nakamoto and Peter J. Schulz. "Intentional and unintentional medication non-adherence in hypertension: The role of health literacy, empowerment and medication beliefs." J Public Health Res 5 (2016): jphr-2016.

Google Scholar Cross Ref Indexed at

5. Xu, Mengqi, Suzanne Hoi Shan Lo, Elaine Yi Ning Miu and Kai Chow Choi. "Educational programmes for improving medication adherence among older adults with coronary artery disease: A systematic review and meta-analysis." Int J Nurs Stud 161 (2025): 104924.

Google Scholar Cross Ref Indexed at