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Drugs don’t work in patients who don’t take them.

  C Everett Koop, MD, US Surgeon General, 1985

Despite strong evidence supporting the benefit of blood pressure (BP) control, the status of hypertension control is less than optimal. Globally, less than half of hypertensive patients are aware of their diagnosis, and BP is controlled in less than one-third of those receiving treatment.1 Hypertension awareness, treatment and control rates have improved substantially in high-income countries since the 1980s and 1990s, but they have plateaued in the past decade.2

Poor adherence to treatment is one common cause of inadequate BP control. More than one-third of patients who were prescribed an antihypertensive drug stopped their initial treatment after 6 months, while about one-half stop after one year.3 Poor adherence to antihypertensive medication has also been shown to be associated with an increased risk of adverse cardiovascular events.4

In this issue of the journal, Jeong et al. report an interesting study on the effect of initial antihypertensive choice on medication persistence and adherence.5 Claims data of the Korean National Health Insurance service were used. A total of 2,919,162 patients newly diagnosed with hypertension between 2011 and 2015 were chosen from the cohort. Medication persistence and adherence were assessed during the subsequent 12 months. The persistence rate was higher with initial combination therapy than with monotherapy. Angiotensin receptor blockers (ARBs) and the combination of ARBs and calcium antagonists were associated with the highest persistence among initial monotherapy and combination therapy, respectively. Adherence showed similar patterns. Monotherapy with ARBs, angiotensin-converting enzyme inhibitors (ACEIs), and calcium antagonists and combination therapy with ARBs/calcium antagonists, ARBs/thiazide and ARBs/calcium antagonists/thiazide showed good adherence.

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INVITED EDITORIAL
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