Int roduct ion: Is adherence to medicat ion the elephant in the room?

Most medications act best when patients take them; and this appears to be the case also for antihypertensive drugs. Unfortunately, there is evidence that patients stop taking treatment that is intended to be taken lifelong. This is unfortunate and will reduce the potential preventive effects of their medication. Thus, adherence to antihypertensive medication is inversely related to cardiovascular outcomes [1]. Similar f indings have been demonstrated in other chronic disease conditions with high cardiovascular risk, such as diabetes [2] and coronary heart disease [3]. Adherence to medication is generally greater in secondary prevention of cardiovascular disease (approximately two thirds adherent) than in primary prevention (approximately one half adherent) [4]. Of note, adherence to cardiovascular preventive medication is generally not related to drug class, suggesting that other factors than side effects are important [4].