Blood pressure and the risk of recurrent vascular disease

1999 world health organization-international society of hypertension guidelines for the management of hypertension

The present Guidelines were prepared by the Guidelines Sub-Committee of the World Health Organization-International Society of Hypertension (WHO-ISH) Mild Hypertension Liaison Committee, the members of which are listed at the end of the text. These guidelines represent the fourth revision of the WHO-ISH Guidelines and were finalised after presentation and discussion at the 7th WHO-ISH Meeting on Hypertension, Fukuoka, Japan, 29th Sept-1st Oct, 1998. Previous versions of the Guidelines were published in Bull WHO 1993, 71:503-517 and J Hypertens 1993, 11:905-918.

1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee of the World Health Organization.

Objective To identify determinants of adherence and assess the impact of structured pharmacist-conducted interviews in determining patients' adherence to prescribed anti-hypertensive medications in a secondary care setting in Nigeria.



Method The study was conducted in a secondary care facility located in Ibadan, Southwestern Nigeria. Two methodological approaches were employed. The first phase was pharmacist-conducted, pre-physician consultation, cross-sectional interviews of 400 hypertensive patients who presented at the study site within the 2-month study period. The second phase was a follow-up review of case notes of these patients after they had left the physician's office.



Key findings The outcome of the pharmacist-conducted pre-physician consultation interview shows that financial difficulty was the most frequently identified factor responsible for patients' non-adherence to anti-hypertensive drug therapy (64%). A drug holiday, varying from 5–14 days per month, was the coping strategy adopted by patients to circumvent this difficulty. Only 48% (192) of patients were aware of the negative consequences of non-adherence with anti-hypertensive drug therapy, and of these, 75% were adherent. The level of awareness was significantly higher in adherent patients (P < 0.001). Sixty-seven per cent (268) of patients use a daily medication reminder (DMR) to assist them in taking their anti-hypertensive drugs, and of these 65.7% were adherent. The use of DMRs was significantly higher among adherent patients (P < 0.01). A meal time was the most frequently used DMR (88%). Forty-one per cent (164) of patients had additional measurement of their blood pressure at pharmacies (65.9%) and neighbourhood private hospital (34.1%), and of these 75.6% were judged to be adherent with their prescribed drug therapy. Additional measurement of blood pressure was significantly higher in adherent patients (P < 0.001). Fifty-one per cent of the cohort were judged by pharmacists as non-adherent during pre-consultation interviews (phase 1), while physicians judged 25% of the same cohort as non-adherent during consultation (phase 2). The structured pharmacist-conducted pre-physician consultation interviews were significantly better at identifying patients who were non-adherent with prescribed anti-hypertensive drugs (P < 0.01).



Conclusion A brief structured pharmacist-conducted interview can be a valuable tool in assessing and/or identifying determinants of adherence with anti-hypertensive drug therapy.

Blood pressure and the risk of recurrent vascular disease

Citations

1999 world health organization-international society of hypertension guidelines for the management of hypertension

1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee of the World Health Organization.

Assessing patient adherence to anti-hypertensive drug therapy: can a structured pharmacist-conducted interview separate the wheat from the chaff?

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