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Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor Emeritus Michel Burnier, University of Lausanne, Switzerland
- Second opponent: Associate Professor Jorie Versmissen, Erasmus University Medical Center, the Netherlands
- Third member and chair of the evaluation committee: Professor Emeritus Trond Geir Jenssen, University of Oslo
Chair of the Defence
Professor Kåre Birkeland, University of Oslo
Principal Supervisor
Aud Høieggen, University of Oslo
Summary
Hypertension can lead to serious illness and premature death. Lifestyle changes and medication are used to lower blood pressure and thereby reduce the risk. In recent years, there has been a focus on the importance of treatment adherence for achieving blood pressure control.
The aim of the thesis was to study important aspects of drug adherence in the treatment of hypertension, i.e. to explore the prevalence of nonadherence as a cause of uncontrolled hypertension in Norway, compare different methods to evaluate adherence, explore factors associated with nonadherence and examine whether information about results of serum drug measurements would improve patients` adherence and blood pressure.
Serum concentrations of 25 antihypertensive drugs were measured in 1) patients treated with a minimum of two antihypertensive agents and 2) patients with resistant hypertension. This objective method of evaluating adherence showed poor compatibility with subjective methods like questionnaires.
Nonadherent patients were younger, had higher blood pressure, were prescribed more antihypertensive tablets and more tablets overall, and they were less frequently prescribed fixed-drug combinations compared to those evaluated as adherent.
1146 patients were included in a national multicenter randomized controlled study to test if information about findings of low or absent serum concentrations of drugs improved blood pressure in patients with uncontrolled hypertension. Forty-six nonadherent patients were randomly assigned to receive information about serum concentrations or not. Adherence and blood pressure improved in both groups, but there was no difference between the groups.
In conclusion, serum drug measurements were useful to detect nonadherence to antihypertensive treatments, but there was no additional improvement in patients` adherence and blood pressure by informing about the results of serum concentrations compared to optimal standard care.
Additional information
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