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Medication Adherence and Blood Pressure Control: A Scientific Statement From the American Heart Association
Open accessAbstract
The widespread treatment of hypertension and resultant improvement in blood pressure have been major contributors to the dramatic age-specific decline in heart disease and stroke. Despite this progress, a persistent gap remains between stated public health targets and achieved blood pressure control rates. Many factors may be important contributors to the gap between population hypertension control goals and currently observed control levels. Among them is the extent to which patients adhere to prescribed treatment. The goal of this scientific statement is to summarize the current state of knowledge of the contribution of medication nonadherence to the national prevalence of poor blood pressure control, methods for measuring medication adherence and their associated challenges, risk factors for antihypertensive medication nonadherence, and strategies for improving adherence to antihypertensive medications at both the individual and health system levels.
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“Single-pill antihypertensive combinations may improve medication-taking behavior in some individuals (60,61).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [60]
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“Addressing existing disparities through targeted strategies, such as optimizing NHIS reimbursement mechanisms and strengthening medication supply chains, could enhance medication adherence and overall health outcomes for hypertensive patients [53].”
InfluentialParvan, R., Aboumsallem, J. P., Meijers, W. C., de Boer, R. A., & Danser, A. H. J. (2024) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2024.177110 · Cited by 7
Okobi, O., Nwogwugwu, E., Ihezie, C., Olasupo, O. O., Emovon, C. I., Wambai-Sani, H., Ezie, O., Afolabi, A. R., Erinne, O., & O’dare, R. A. (2024) · Cureus · doi:10.7759/cureus.66604 · Cited by 4
“These findings are consistent with previous studies which reported that gender differences persist in medication usage, with females more likely than males to take medication for high blood pressure, while males show higher rates for high cholesterol medication [19].”
BackgroundResultKim, H.-L., Park, S., Bae, Y., Ihm, S. H., Shin, J.-H., & Kim, K. (2024) · Clinical Hypertension · doi:10.1186/s40885-024-00264-x · Cited by 4
“By taking AHM as directed, individuals can achieve and maintain optimal blood pressure (BP) levels, significantly reducing the risks associated with uncontrolled hypertension [4–7].”
BackgroundLiu, T., Zhao, X., Huang, M., Yang, Y. X., Chen, Z., He, X., Li, X., & Jiang, W. (2023) · PeerJ · doi:10.7717/peerj.16384 · Cited by 5
Borghi, C., & Granados, D. (2023) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0000000000001494 · Cited by 5
Sözmen, K., Ergör, G., Sakarya, S., Dinç, G., Şahan, C., Ekinci, B., Arikan, A., Sis, S., & Ünal, B. (2023) · Medicina · doi:10.3390/medicina59081366 · Cited by 3
Fogacci, F., Esposti, D. D., Micoli, A. D., Fiorini, G., Veronesi, M., Borghi, C., & Cicero, A. F. G. (2023) · Phytotherapy Research · doi:10.1002/ptr.7951 · Cited by 4
“On the other side, the single molecules per se seem to exert a significant BP-lowering effect only when taken at a high dosage and more times a day (Cicero et al., 2019): this could decrease patients' adherence to the treatment on the long-term (Choudhry et al., 2022).”
Aielo, A. N., Santos, R. B., Giatti, S., Silva, W. A., Parise, B. K., da Cunha, L. F., Souza, S. P., Lotufo, P. A., Benseñor, I. M., & Drager, L. F. (2023) · Sleep Medicine · doi:10.1016/j.sleep.2023.02.025 · Cited by 5
A Medicaid Statewide Hypertension Quality Improvement Project: Initial Results
Bolen, S. D., Koroukian, S. M., Wright, J. T., Persaud, H., Einstadter, D., Fiegl, J., Perzynski, A. T., Gunzler, D. D., Sullivan, C., Lever, J., et al. (2023) · Cureus · doi:10.7759/cureus.36132 · Cited by 4
“Further exploration of this measure, enhanced availability of 90-day prescription refills, and addressing other barriers related to medication taking are essential [33,34].”
BackgroundKoya, S., Pilakkadavath, Z., Wilson, T., Chandran, P., Kuriakose, S., Akbar, S., & Ali, A. (2022) · medRxiv · doi:10.1101/2022.04.09.22273638 · Cited by 4
Chen, S., Fang, Y., Ding, L., Mo, P. K. H., & Wang, Z. J. (2026) · PLOS Digital Health · doi:10.1371/journal.pdig.0001507 · Cited by 4
“…that no competing interests exist. self-management; (ii) reminder systems that track medication use and provide adherence feedback; (iii) regimen simplification, such as fixed-dose combinations; and (iv) financial incentives, including reduced co-payments or performance-based rewards [10,11].”
Adhikari, S., Stokes, T., Li, X., Zhao, Y., Fitchett, C., Ladino, N., Lawrence, S., Qian, M., Cho, Y., HAMO, C. E., et al. (2025) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocaf162 · Cited by 4
Self-citationPrevalensi dan determinan kepatuhan konsumsi obat pada penderita hipertensi: studi cross-sectional
Rifai, A., Kasim, F., Widyaningsih, F., Rambey, H., Bangun, S. M. B., & Indriani, R. (2025) · Haga Journal of Public Health (HJPH) · doi:10.62290/hjph.v2i3.56 · Cited by 3
Chen, X., Meng, J., Zhou, Q., Ni, Y., Zuo, C., & Zhang, Y. (2025) · Journal of Clinical Hypertension · doi:10.1111/jch.70080 · Cited by 4
Razzak, J., Ali, N., Khan, U. R., Ismail, M., Khan, B. A., Raheem, A., Agrawal, P., & Bhatti, J. A. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0003948 · Cited by 3
Chemical adherence testing in the clinical management of hypertension: a scoping review
Rabbitt, L., Curneen, J. M. G., Dennedy, M. C., & Molloy, G. J. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1452464 · Cited by 3
Basu, S., Maheshwari, V., Malik, M., Barzangi, K., & Hassan, R. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0003413 · Cited by 2
“Furthermore, in existing patients with DM and/or HTN with abdominal obesity, adherence to medications apart from healthy lifestyle and self-care is crucial for maintaining controlled blood glucose and reduced blood pressure levels that reduce the risk of complications [16,17].”
BackgroundMobed, A., Gholami, S., Tahavvori, A., Ghazi, F., Masoumi, Z., Alipourfard, I., Naderian, R., & Mohammadzadeh, M. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e19467 · Cited by 3
“3 past, clinician perceptions of the BP level required for treatment were highly variable and often different from published guidelines [11].”
BackgroundDeterminant factors of treatment adherence of hypertensive patients in a rural area of Indonesia
Visuddho, V., Kurniawan, P. A. P., Rafidah, S. F., Zamzam, R. R., bin Roslan, E. S., Habibi, M. R., Yaşargil, M. G., Atika, A., & Supratiwi, A. (2023) · Journal of Ideas in Health · doi:10.47108/jidhealth.vol6.iss2.281 · Cited by 3
Schwalm, J., Ivers, N., Bouck, Z., Taljaard, M., Natarajan, M., Nguyen, F., Hijazi, W., Thavorn, K., Dolovich, L., McCready, T., et al. (2022) · BMC Medicine · doi:10.1186/s12916-022-02401-5 · Cited by 3
Adherence and blood pressure control in patients with primary aldosteronism
Nguyen, T. M. P. N., Štrauch, B., Petrák, O., Krátká, Z., Holaj, R., Kurcová, I., Marešová, V., Pilková, A., Hartinger, J. M., Waldauf, P., et al. (2022) · Blood Pressure · doi:10.1080/08037051.2022.2061416 · Cited by 5
European Hypertension Guidelines: Similarities and What the Practicing Physician Should Keep in Mind
Zeniodi, M. E., Τσαγανός, Θ., Menti, A., Komnianou, A., Κόλλιας, Α., & Stambolliu, E. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15020859 · Cited by 2
Dewi, S., Almahdy, A., Dasman, H., Syofyan, S., & Hafifah, A. S. (2025) · Contagion: Scientific Periodical Journal of Public Health and Coastal Health · doi:10.30829/contagion.v7i2.24419 · Cited by 2
“Nevertheless,. Choudhry et al., (2021) reported that patients with controlled hypertension tend to exhibit higher levels of compliance compared to those with uncontrolled blood pressure.”
Medication Adherence in the Real World: Lessons from the Diuretic Comparison Project
Hynes, C. A., Hau, C., Woods, P., Leatherman, S., Anand, S. T., Glassman, P. A., Taylor, A. A., Cushman, W. C., Ishani, A., & Ferguson, R. E. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14165695 · Cited by 2
“Consequently, adherence in this population may have been higher than in individuals with newly diagnosed HTN initiating therapy, among whom first-year non-persistence rates have been reported to range from 30% to 80% [8].”
Wong, W. J., Nguyen, T. V., Nguyen, V. T., Ngo, T. T. K., & Nguyen, T. N. (2025) · Journal of Clinical Hypertension · doi:10.1111/jch.70105 · Cited by 3
Kern, K. C., Crossley, A., Wu, N., Mun, K. T., Dergalust, S., & Hinman, J. D. (2025) · Journal of Stroke & Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2025.108257 · Cited by 2
Ultrasound renal denervation in hypertensive patients: A systematic review and meta-analysis
Ramadhan, R. N., Rampengan, D. D. C. H., Gunawan, F. A., Nathania, N., Willyanto, S. E., Yamada, H., Thaha, M., Suryantoro, S. D., & Empitu, M. A. (2025) · PLoS ONE · doi:10.1371/journal.pone.0311191 · Cited by 2
Hou, T., Yu, L., Shi, X., Zhen, Y., Ji, L., Wei, Z., & Xu, Y. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1424683 · Cited by 3
Miyazaki, M., Hirata, H., Takaki, S., Misaki, M., Mori, Y., Tokura, K., Sato, N., Nakashima, A., Yanagida, A., Okajima, I., et al. (2024) · Pharmacy · doi:10.3390/pharmacy12050153 · Cited by 2
“Indirect methods include pill counting, electronic monitoring, and formulations such as the proportion of days covered or the medication possession ratio [11,12], whereas direct methods include the measurement of drug concentrations in body fluids, such as the blood or urine [13].”
Method
Metadata
- Authors
- Choudhry, N. K., Kronish, I. M., Vongpatanasin, W., Ferdinand, K. C., Pavlik, V. N., Egan, B. M., Schoenthaler, A., Houston Miller, N., Hyman, D. J., & on behalf of the American Heart Association Council on Hypertension; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology
- ORCID
- Venue
- Hypertension
- Published
- 2022-01
- Volume
- 79
- Issue
- 1
- Pages
- e1-e14
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC11485247
- OpenAlex
- W3204423521
- Cited by
- 349
- References
- 119
- Citations by year
- 2026: 89 · 2025: 68 · 2024: 62 · 2023: 85 · 2022: 41
- FWCI
- 52.39
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01 HS026522)
- National Heart, Lung, and Blood Institute (R25HL105444)
- National Institute on Minority Health and Health Disparities (R01MD013769)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- medication adherence, medication non-adherence, blood pressure control, antihypertensive drugs, adherence measurement, risk factors for non-adherence, adherence interventions, health system interventions, cardiovascular disease prevention
- MeSH terms
- American Heart Association, Antihypertensive Agents, Blood Pressure, Humans, Hypertension, United States, Medication Adherence
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