Clinical Medicine Reviews in Patient Care

The prevention and treatment of hypertension is a public health challenge, in part because most patients treated for hypertension do not achieve adequate blood pressure (BP) control. Noncompliance is a common cause, influenced by factors such as tolerability, tablet load, complexity, efficacy, and cost. Additionally, patients may question the need for lifetime treatment of an asymptomatic condition with medications that often reduce their quality of life. Clinical inertia, underdosing, and limited use of combination and new treatments also contribute. Strategies to improve BP control include the use of highly effective, long-acting, and well-tolerated antihypertensives that encourage adherence, with efficacy that extends beyond the 24-hour dosing period to provide lasting protection and mitigation against the effects of missed doses. Angiotensin receptor blockers (ARBs) encourage higher adherence than other antihypertensives, and the ARB telmisartan offers 24-hour BP reductions. Ultimately, successful management of hypertension requires the physician to help the patient understand the seriousness of their condition, the implications of noncompliance, and the need for lifetime treatment.