High blood pressure, also known as hypertension, affects approximately 1.4 billion people aged 30-79 years old across the world. Amongst those impacted, only about 320 million manage their condition effectively (1). This places the over 1 billion people who don’t have their condition under control at an increased risk of various complications—including heart attacks, heart failure, and strokes (1;2).
While the global story of high blood pressure reads like a scary one, there are various strategies available to help us get our blood pressure back in check. As a first step, healthcare providers often recommend lifestyle changes such as consuming a healthy diet, exercising, losing weight, and reducing stress (3). But lifestyle changes alone may not work well enough for everyone, so the addition of one or more blood pressure lowering medications to the treatment plan is generally the next step. There are a range of medications, each with their own way of reducing blood pressure. The most common types of medication are:
- ACE inhibitors and ARBs: Relax the blood vessels and decrease the reabsorption of sodium in the kidneys.
- Beta blockers: Prevent an increase in heart rate and the constriction of blood vessels causing the blood vessels to relax.
- Calcium channel blockers: Widen the blood vessels.
- Diuretics: Increase the kidneys' elimination of sodium into the urine and decrease blood volume.
Up to 40% of people prescribed blood pressure lowering medications don’t take their medication as outlined by their healthcare provider. This can look like skipping a dose, not taking the correct dose, or stopping the medication on their own. In fact, within one year of being prescribed a blood pressure lowering medication, as many as half of patients stop taking it (4). Why might this be? It’s a complex issue! A variety of reasons can contribute to lack of medication adherence, including out-of-pocket expenses, access to treatment, having to take multiple medications daily or weekly, poor memory, inadequate communication from a healthcare provider, and experiencing negative side effects (5-6).
To motivate adherence, let’s look at a systematic review to learn more about some of the benefits of blood pressure lowering medications in older adults living with high blood pressure (3). Additionally, let’s highlight some strategies that may help us stay on track.
What the research tells us
The review found that in older adults living with moderate to severe high blood pressure and who have never had a heart attack or stroke, blood pressure lowering medications reduce the risk of death from any cause compared to placebo or no treatment. We can be highly confident in this result. Additionally, these medications likely reduce the risk of death and illness from issues related to the heart and blood vessels, such as heart attack, stroke, and coronary heart disease. We can be moderately confident in these results. If you’re wondering which age group of older adults benefits most from this strategy, it appears to be those aged 60-79. It’s also important to note that while the review included a variety of medication types—such as beta blockers, calcium channel blockers, and ACE inhibitors, the most common was the diuretic thiazide. So, many of these results apply to this specific medication type.
Lastly, in terms of safety, more people taking medications left the studies they were involved in early due to negative side effects compared to those receiving a placebo or no treatment. We have low confidence in this finding, meaning more research is needed and could change the results we see here (3). Ultimately, people should work with their healthcare team to weigh the benefits and harms of different medications and choose what is most appropriate for their specific health situation.
Strategies to help with medication adherence:
- Get organized: Use pill boxes to divide medications for the day or week. If needed or preferred, set-up automatic medication refills and delivery with your pharmacy (generally free), but be sure to discuss considerations and restrictions you should be aware of with the pharmacist (availability of such services may vary by pharmacy).
- Form habits: Align medication intake with other daily activities like brushing your teeth, making a meal, etc.
- Incorporate technology: Sign up to receive text message reminders from your healthcare team (if available), set reoccurring alarms on your mobile devices, or use apps that allow you to set reminders, track medication use, and alert caregivers of missed doses.
- Review medications: Regularly review your medications with a pharmacist or doctor to ensure that you’re taking the correct medications at the right dose and frequency, discuss side effects, identify and address potentially harmful interactions, and determine where your routine can be simplified or adjusted (e.g., single pills that combine multiple medications, medication removal, etc.).
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