Medication Adherence: Can a Simple Review Make a Big Difference?
"Unpacking how pharmacotherapy reviews can empower hypertensive patients to take control of their health and improve medication adherence."
For adults managing hypertension, consistent medication is essential, and often involves multiple drugs to address the condition, reduce risk factors, and manage complications. However, this complexity can lead to a common challenge: low medication adherence, hindering effective blood pressure control and increasing the risk of complications.
Non-adherence to medication is a widespread issue, with the World Health Organization estimating that approximately 50% of patients forget to take their medications as prescribed. In Brazil, studies reveal that only about a third of hypertensive patients consistently adhere to their medication plans.
Pharmacotherapy review provides a potential solution. It's a structured assessment that fosters a collaborative partnership between patients and healthcare providers, ensuring treatment goals are understood, dosages are agreed upon, and administration schedules are clear. By focusing on improving medication adherence through optimized schedules, can pharmacotherapy reviews improve health outcomes for hypertensive patients?
Adherence Review and Blood Pressure Control
Medication adherence is important in clinical trials and in managing chronic conditions, including treatment-resistant hypertension. A 2025 evaluation reported that adherent patients had higher rates of blood pressure control, yet only 43% of adherent patients were at target, indicating that adherence alone may not be enough and treatment escalation may still be needed. A patient-centered approach with nonjudgmental communication, collaborative multidisciplinary care, and patient engagement through self-monitoring is described as a way to improve adherence.
Milestones in Hypertension Treatment
The Veterans Administration cooperative study was a major milestone: its first adequately powered placebo-controlled randomized trial of antihypertensive therapy examined hydrochlorothiazide, reserpine, and hydralazine against placebo in 143 veterans with severe hypertension. Across subsequent decades, hypertension treatment developed from early drug approaches to more tolerable and effective medicines and interventional techniques, including renal denervation, AV fistulas, and autonomic devices. A 2021 review also reported associations between good adherence and factors including age 65 or older, diabetes medication use, family history of hypertension or cardiovascular disease, and use of at least two classes of antihypertensive medication.
How a Pharmacotherapy Review Works: A Step-by-Step Approach
A research study published in the Brazilian Journal of Pharmaceutical Sciences investigated the impact of pharmacotherapy reviews on medication adherence and blood pressure control among hypertensive patients. The study followed an uncontrolled intervention model, divided into three distinct stages:
- Stage 1: Initial Assessment: Researchers gathered data on patient demographics, medication history, daily routines, physical activity, diet, and stress levels. They assessed medication adherence using the Morisky-Green test and a self-evaluation scale. Blood pressure was also measured.
- Stage 2: Review and Intervention: Patients received a personalized pharmacotherapy review report, incorporating their daily routines. The report outlined optimized medication schedules and addressed potential drug-food interactions.
- Stage 3: Follow-Up Evaluation: After four to six weeks, researchers reassessed medication adherence using the Morisky-Green test, self-evaluation, and blood pressure measurements. They also gathered patient feedback on the review report and its impact on their adherence.
Medication Review and Dosing-Instruction Research
An overview of systematic reviews on pharmacist-participated medication review found that most included reviews were conducted in Europe (7), and most included controlled primary studies (16); elderly patients and long-term care facilities were also common, appearing in 9 and 8 reviews, respectively. Research at the University of Gondar comprehensive specialized hospital found that misunderstanding dosage instructions was significantly associated with sex, educational level, residence, and duration of medication use. A 2025 cluster-randomized study set out to test a multicomponent intervention that used linked electronic health record and pharmacy data to identify patients with uncontrolled hypertension and nonadherence, then used team-based care to address barriers.
Adherence Does Not Guarantee Blood Pressure Control
Suboptimal adherence can include not starting pharmacotherapy, taking medication less often than prescribed, or not persisting with treatment over time; it is recognized as a contributor to poor blood pressure control. However, failure to control blood pressure despite multiple prescribed antihypertensive medications is also widespread and associated with worse clinical outcomes. In a 2025 evaluation, blood pressure was below target in only 43% of adherent patients, underscoring that adherence does not always resolve uncontrolled hypertension.
Key Findings and the Path Forward
The study revealed significant improvements in medication adherence, as measured by both the Morisky-Green test (p<0.001) and self-reported assessments (p=0.004). Furthermore, there was a notable improvement in blood pressure control, with significant reductions in both systolic (p<0.001) and diastolic (p=0.002) blood pressure levels, and an increased number of patients achieving controlled hypertension (p=0.006).
Class-Specific Adherence and Future Strategies
A retrospective cohort study analyzed antihypertensive medication adherence among commercially insured adults aged 18–64 from 2018 to 2023 using Merative MarketScan data. Its accompanying discussion emphasizes evaluating adherence by medication class, since classes differ in mechanisms of action, dosing schedules, side-effect profiles, and patient acceptance, and notes the importance of considering the pandemic's effect on adherence. A systematic review proposal says its findings are intended to clarify predictors and evidence gaps and guide future strategies, including simplified regimens, digital tools, and population-specific hypertension policies.
Addressing Multiple Adherence Behaviors
Medication adherence among people with hypertension remains a challenge. The source calls for future research into complex interventions that combine evidence-based strategies and target multiple adherence behaviors, including long-term medication adherence. It presents this as an area for further investigation into how such interventions can improve adherence.
Pharmacists’ Role in Everyday Medication Use
A 2023 case report described pharmacist interventions that included managing self-medication, collaborating with a general practitioner on prescribing changes, and counselling a patient about medication use and adherence. Although the drug-related problems in that case were not serious, the authors noted that the patient could have benefited from pharmacist intervention. A 2025 analysis of a sizable older cohort with hypertension found nonadherence proportions comparable to national trends among US older adults taking blood pressure medication.
While the pharmacotherapy review enhanced medication adherence and blood pressure control, it also led to a slight increase in the complexity of treatment regimens. This highlights the importance of ongoing support and education to help patients manage their medication schedules effectively.
Pharmacotherapy reviews hold considerable promise for improving medication adherence and hypertension management. Further research is needed to explore the long-term effects of these interventions and to identify strategies for optimizing their implementation in community pharmacies. By empowering patients with knowledge and support, we can significantly improve health outcomes and reduce the burden of hypertension.