TOPLINE:

Patients with hypertension and uncontrolled blood pressure (BP) who showed improved medication adherence and received intensified treatment had the highest probability of achieving controlled BP.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to evaluate whether improving adherence, intensifying antihypertensive medications, or both affected BP control.
• They included 19,441 patients with hypertension (median age, 68 years; 56% female) who had two uncontrolled office BP readings (≥ 130/80 mm Hg) in 2021 at a large health system in the Midwest. The second visit, 8-180 days after the first, was considered the index visit.
• Adherence was calculated from pharmacy fills across all antihypertensives for the 6 months before and after the index visit and classified as high (≥ 80%) vs low (< 80%).
• Intensification of medication was defined as prescribing a higher dose or new medication class within 7 days of the index visit.
• BP control was defined as a reading < 130/80 mm Hg, measured between 30 and 270 days after the index visit.

TAKEAWAY:

• Medication was intensified in 50% of patients before the index visit and in 24% at the index visit.
• Patients with prior intensification and high adherence before the visit had the highest chance of receiving intensification at the index visit (28%). Patients without prior intensification had the lowest chance (21%) regardless of adherence status.
• Among patients with low adherence before the index visit, 47% became highly adherent afterward. Intensified medication was associated with 20% higher odds of improved adherence (P = .02).
• In the low previsit adherence group, the probability of BP control was 24% with intensification alone, 25% with improved adherence alone, and 23% with neither action. Patients who received both actions had the highest chance of BP control compared with those who received no action (31%; P < .01).

IN PRACTICE:

“To achieve BP control, physicians and health systems should continue to appropriately intensify medication, even in situations where patients are poorly adherent. In these circumstances, physicians should address both adherence and intensification together,” the researchers of this study wrote.

SOURCE:

This study was led by Paul Sabharwal, Cleveland Clinic Lerner College of Medicine, Cleveland. It was published online on November 25, 2025, in Hypertension.

LIMITATIONS:

This observational study was conducted at a single health system. Adherence was measured with prescription fill data, which did not confirm whether patients took their medications on visit days. Researchers could not determine the rationale for physicians deciding to intensify medications.

DISCLOSURES:

This study did not receive any specific funding, and the authors did not report having any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.