Department of Hospital Pharmacy.
Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam.
J Hypertens. 2022 Jan 1;40(1):189-193. doi: 10.1097/HJH.0000000000003001.
Nonadherence to antihypertensive drugs is an important reason for not reaching blood pressure goals. A possible method to improve nonadherence involves three essential steps: identification of nonadherent patients (step 1), determination of underlying causes (step 2) and a personalized solution (step 3). We present three unique cases to show the importance and difficulties of this three-step approach. Patients participated in a randomized controlled trial to improve nonadherence to antihypertensive drugs (RHYME-RCT, Dutch Trial Register NL6736). Drug level measurements were used to identify nonadherence to antihypertensive drugs and communication on drug levels was supported by a tailored feedback tool in these patients. These cases showed that a three-step approach of identifying nonadherence and determination of the underlying cause, can lead to a personalized solution to improve therapy even when nonadherence was excluded. Open communication with patients remains an essential part when improving nonadherence.
不遵守抗高血压药物治疗是未达到血压目标的一个重要原因。提高依从性的一种可能方法包括三个基本步骤：识别不依从的患者（步骤 1）、确定潜在原因（步骤 2）和制定个性化解决方案（步骤 3）。我们提出三个独特的病例，以说明这三步方法的重要性和困难。患者参加了一项旨在提高抗高血压药物依从性的随机对照试验（RHYME-RCT，荷兰试验注册 NL6736）。药物水平测量用于识别抗高血压药物的不依从性，并通过针对患者的定制反馈工具支持药物水平的沟通。这些病例表明，即使排除了不依从性，识别不依从性和确定潜在原因的三步方法可以制定个性化的解决方案来改善治疗。改善不依从性时，与患者的开放沟通仍然是一个重要部分。
