Improving patient adherence to high blood pressure medication

High blood pressure (hypertension) is the leading cause of death globally, affecting more than 1.4 billion people and accounting for more than 28,000 deaths each day, almost three times the peak rate seen during the COVID-19 outbreak. A collaborative research programme led by The University of Manchester examined patients with high blood pressure and discovered that nearly one-third were not taking their blood pressure-lowering tablets on a regular basis.

Key facts

  • High blood pressure is the leading cause of death globally, but nearly one-third of patients do not take their medication regularly.
  • We developed a urine test to identify these patients and better support them to take their medication (called adherence).
  • 50% of patients tested became completely adherent and their blood pressure dropped considerably.
  • The test is now available as a service to patients across Manchester and is recommended in Global Hypertension Practice Guidelines.

One of the adherence projects in the programme at Manchester showed that repeating a urine test to confirm the presence of commonly prescribed antihypertensive medications is associated with a drop in blood pressure in hypertensive patients.

By identifying patients who had been struggling to regularly take their medication, the test allows patients and doctors to discuss the reasons behind this. Doctors can then act on these barriers and provide the support the patients need to adhere to the treatment regimes.

The study showed a notable drop in blood pressure in these patients between the urine test and the final clinic visit. Over 50% of the patients who took the urine test became completely adherent to their prescribed blood pressure-lowering treatment and a further 30% of patients improved their adherence.

Maciej Tomaszewski

Professor Maciej Tomaszewski

Maciej is Chair in Cardiovascular Medicine at The University of Manchester.

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It is estimated that such a significant drop in blood pressure may translate into a 45% reduction in the risk of coronary heart disease and a 65% reduction in the risk of stroke.

Helping patients to help themselves

To what extent the risk is reduced in the UK population is currently being investigated in the British Heart Foundation-funded OUTREACH study.

This clinical trial is looking at the effects of clinical management of anti-hypertensive treatment on controlling patients' high blood pressure. The aim is to help patients better control their blood pressure with their current medicines, without the need for more tests, hospital appointments and medications.

New clinical guidelines for high blood pressure

The simple-to-use urine test is now available as a service to patients in Manchester.

Our work has contributed to the 2020 International Society of Hypertension Global Hypertension Practice Guidelines, which put a particular emphasis on screening for non-adherence to antihypertensive treatment using objective direct methods such as urine analysis.