Only about 58% of adults with hypertension take their tablets as prescribed

Design

Systematic review and meta-analysis of 123 studies

Population

1,052,445 adults with hypertension worldwide

Primary outcome

Pooled prevalence of adherence to antihypertensives

Effect

58% (95% CI 52 to 63%); high adherence 39%, low adherence 35%

This meta-analysis pooled 123 studies covering more than a million adults with hypertension. About 58% were adherent to their antihypertensives, with large differences between continents, from 45% in North America to 67% in Europe. Country income made little difference.

Only age and the tool used to measure adherence were linked to the estimate in the adjusted model. That second point matters: adherence measures vary, from self-report questionnaires to pill counts, and the true figure depends heavily on how it is measured.

In practice, the finding supports checking adherence early whenever blood pressure stays high, and simplifying regimens where possible. Single-pill combinations are widely available and inexpensive in India.

• Pooled adherence was 58%; about a third of patients had low adherence.
• Adherence was similar across low-, middle- and high-income countries, at 56 to 61%.
• Asia, at 56%, sat close to the global average.
• Single-pill combinations and once-daily dosing reduce the number of tablets to forget.
• Ask a specific question, such as how many doses were missed last week, rather than whether they take their medicines.

Why it matters

Poor adherence is the commonest reason for apparent treatment failure, and it is as common in high-income settings as in low-income ones.

Don't overread it

Adherence was measured in many different ways, so the pooled figure is an approximation, not a benchmark for any one practice.

The statistics, in plain English

The pooled figure has a narrow interval, but the studies differed a lot from each other, so 58% is an average across very different settings rather than a precise figure for any one clinic.

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