Munger Mark A, Van Tassell Benjamin W, LaFleur Joanne
Departments of Pharmacotherapy and Internal Medicine, University of Utah, Salt Lake City, Utah, USA.
MedGenMed. 2007 Sep 19;9(3):58.
Nonadherence with prescribed drug regimens is a pervasive medical problem. Multiple variables affecting physicians and patients contribute to nonadherence, which negatively affects treatment outcomes. In patients with hypertension, medication nonadherence is a significant, often unrecognized, risk factor that contributes to poor blood pressure control, thereby contributing to the development of further vascular disorders such as heart failure, coronary heart disease, renal insufficiency, and stroke. Analysis of various patient populations shows that choice of drug, use of concomitant medications, tolerability of drug, and duration of drug treatment influence the prevalence of nonadherence. Intervention is required among patients and healthcare prescribers to increase awareness of the need for improved medication adherence. Within this process, it is important to identify indicators of nonadherence within patient populations. This review examines the prevalence of nonadherence as a risk factor in the management of chronic diseases, with a specific focus on antihypertensive medications. Factors leading to increased incidence of nonadherence and the strategies needed to improve adherence are discussed. Medication nonadherence, defined as a patient's passive failure to follow a prescribed drug regimen, remains a significant concern for healthcare professionals and patients. On average, one third to one half of patients do not comply with prescribed treatment regimens.[1-3] Nonadherence rates are relatively high across disease states, treatment regimens, and age groups, with the first several months of therapy characterized by the highest rate of discontinuation.[3] In fact, it has recently been reported that low adherence to beta-blockers or statins in patients who have survived a myocardial infarction results in an increased risk of death.[4] In addition to inadequate disease control, medication nonadherence results in a significant burden to healthcare utilization - the estimated yearly cost is $396 to $792 million.[1] Additionally, between one third and two thirds of all medication-related hospital admissions are attributed to nonadherence.[5,6]Cardiovascular disease, which accounts for approximately 1 million deaths in the United States each year, remains a significant health concern.[7] Risk factors for the development of cardiovascular disease are associated with defined risk-taking behaviors (eg, smoking), inherited traits (eg, family history), or laboratory abnormalities (eg, abnormal lipid panels).[7] A significant but often unrecognized cardiovascular risk factor universal to all patient populations is medication nonadherence; if a patient does not regularly take the medication prescribed to attenuate cardiovascular disease, no potential therapeutic gain can be achieved. Barriers to medication adherence are multifactorial and include complex medication regimens, convenience factors (eg, dosing frequency), behavioral factors, and treatment of asymptomatic conditions.[2] This review highlights the significance of nonadherence in the treatment of hypertension, a silent but life-threatening disorder that affects approximately 72 million adults in the United States.[7] Hypertension often develops in a cluster with insulin resistance, obesity, and hypercholesterolemia, which contributes to the risk imposed by nonadherence with antihypertensive medications. Numerous strategies to improve medication adherence are available, from enhancing patient education to providing medication adherence information to the healthcare team and will be discussed in this article.
不遵医嘱服药是一个普遍存在的医学问题。影响医生和患者的多个变量导致了不遵医嘱，这对治疗结果产生了负面影响。在高血压患者中，药物治疗不依从是一个重要的、常常未被认识到的危险因素，它会导致血压控制不佳，进而促使进一步的血管疾病如心力衰竭、冠心病、肾功能不全和中风的发生。对不同患者群体的分析表明，药物的选择、联合用药情况、药物耐受性以及药物治疗持续时间会影响不依从的发生率。患者和医疗处方者都需要进行干预，以提高对改善药物依从性必要性的认识。在此过程中，识别患者群体中不依从的指标很重要。本综述探讨了不依从作为慢性病管理中的一个危险因素的发生率，特别关注抗高血压药物。讨论了导致不依从发生率增加的因素以及提高依从性所需的策略。药物治疗不依从被定义为患者被动地不遵循规定的药物治疗方案，仍然是医疗专业人员和患者的一个重大关切。平均而言，三分之一到一半的患者不遵守规定的治疗方案。[1 - 3]在各种疾病状态、治疗方案和年龄组中，不依从率相对较高，治疗的前几个月停药率最高。[3]事实上，最近有报道称，心肌梗死幸存者中对β受体阻滞剂或他汀类药物的低依从性会导致死亡风险增加。[4]除了疾病控制不佳外，药物治疗不依从还给医疗利用带来了巨大负担——估计每年的费用为3.96亿至7.92亿美元。[1]此外，所有与药物相关的住院病例中有三分之一到三分之二归因于不依从。[5,6]心血管疾病在美国每年导致约100万人死亡，仍然是一个重大的健康问题。[7]心血管疾病发展的危险因素与特定的风险行为（如吸烟）、遗传特征（如家族病史）或实验室异常（如血脂异常）有关。[7]所有患者群体中一个重要但常常未被认识到的心血管危险因素是药物治疗不依从；如果患者不定期服用为减轻心血管疾病而开的药物，就无法获得潜在的治疗益处。药物依从性的障碍是多方面的，包括复杂的药物治疗方案、便利因素（如给药频率）、行为因素和无症状疾病的治疗。[2]本综述强调了不依从在高血压治疗中的重要性，高血压是一种无声但危及生命的疾病，在美国影响着约7200万成年人。[7]高血压常常与胰岛素抵抗、肥胖和高胆固醇血症同时出现，这增加了不服用抗高血压药物所带来的风险。有许多提高药物依从性的策略，从加强患者教育到向医疗团队提供药物依从性信息，本文将对此进行讨论。
