Medication non-adherence as a critical factor in the management of presumed resistant hypertension: A narrative review

Sabina De Geest, Todd Ruppar, Lut Berben, Sandra Schönfeld, Martha N. Hill

Research output: Contribution to journalReview articlepeer-review

23 Scopus citations


Aims: Medication non-adherence is a crucial behavioural risk factor in hypertension management. Fortythree to 65.5% of patients with presumed resistant hypertension are non-adherent. This narrative review focuses on the definition of adherence/non-adherence, measurement of medication adherence, and the management of medication non-adherence in resistant hypertension using multilevel intervention approaches to prevent or remediate non-adherence. Methods and results: A review of adherence and resistant hypertension literature was conducted. Medication adherence consists of three different yet related dimensions: initiation, implementation, and discontinuation. To effectively measure medication non-adherence, a combination of direct and indirect methods is optimal. Interventions to tackle medication non-adherence must be integrated in multilevel approaches. Interventions at the patient level can combine educational/cognitive (e.g., patient education), behavioural/ counselling (e.g., reducing complexity, cueing, tailoring to patient's lifestyle) and psychological/affective (e.g., social support) approaches. Improving provider competencies (e.g., reducing regimen complexity), implementing new care models inspired by principles of chronic illness management, and interventions at the healthcare system level can be combined. Conclusions: Improvement of patient outcomes in presumed resistant hypertension will only be possible if the behavioural dimensions of patient management are fully integrated at all levels.

Original languageEnglish (US)
Pages (from-to)1102-1109
Number of pages8
Issue number9
StatePublished - Jan 2014


  • Assessment
  • Intervention
  • Medication adherence
  • Persistence
  • Resistant hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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