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Heart disease—including heart attacks and strokes—represents the leading cause of death in the USA [1]. High blood pressure (HBP)—also known as hypertension—is a key risk factor for heart disease. According to the most recent guidelines from the American Heart Association and American College of Cardiology, a systolic blood pressure of 130 mmHg or higher or a diastolic blood pressure of 80 mmHg or higher signifies HBP [2]. A third of US adults—75 million individuals—have HBP, and this contributed to over 635,000 heart disease–related deaths in 2016 [3]. About 10% of HBP is due to a specific, treatable cause and is reversible by treating the underlying condition [2]. For the remaining 90% of patients, HBP cannot be reversed, although it can be controlled through lifestyle changes and medication. For example, a change in diet may reduce HBP as much as 11.4 mmHg (systolic) and 5.5 mmHg (diastolic) in patients with hypertension, within approximately 8 weeks [4]. Adherence to HBP medication has been shown to have an even larger effect. For example, a review of clinical trials illustrated that single drug therapy for loop diuretics (a class of HBP medications) may reduce HBP as much as 15.8 mmHg (systolic) and 8.2 mmHg (diastolic) in patients with hypertension, within a week’s time [5].
Although medication may have the most immediate impact on HBP, patients with hypertension often struggle with adhering to their medication regimens. Medication adherence has been broadly defined as taking medication as prescribed, and involves initiation of the treatment, taking the correct dose at the correct time, and taking the medication for as long as it is needed [6]. Nearly half of HBP medication regimens are not followed [7]. Previous studies describe numerous barriers that patients with HBP encounter to medication adherence, including the following: challenges that emerge in everyday life such as forgetting and physical challenges such as dealing with undesirable side effects, as well as psychological challenges such as depression, and financial challenges such as cost [8–11]. To address these medication adherence barriers, previous studies have identified approaches that support adherence, including the following: a consistent routine, support from family and friends, engagement with a pharmacy, and a trusting, positive relationship with a health care provider [12–16].
Medication adherence studies show differences in adherence...