Letter to the Editor Letters to the Editor will be published, if suitable, as space permits. They should not exceed 500 words (typed double-spaced) plus 5 references in length and may be subject to editing or abridgment.
Maximizing Treatment Adherence: Physician– Patient Partnerships vs Procedures
In the August issue of Hypertension, Burnier et al1 open their review article with an encouragingly clear patient focus. They explicitly state effective hypertension management requires 2 types of patient behavior change: lifestyle modification and lifelong adherence to pharmacotherapy. The latter can work, they emphasize, “only if the patient is motivated to take the prescribed medication.” Yet, they fail to address further the critical role the physician should and must play in this process. In fact, the remainder of the article focuses entirely on poor drug adherence, without so much as mentioning lifestyle modification and patient motivation again. Although the authors recognize the challenge of psychosocial hurdles, they completely ignore behavioral interventions, turning instead to a series of therapeutic solutions such as avoiding medication entirely, and advocating investigative procedures whose efficacy, as the authors themselves acknowledge, is currently unproven. I believe this is not merely misguided, but represents precisely the wrong approach to recommend to physicians. It implies that patients are the problem because they cannot be trusted to take their medication and, as clinicians, we must find our own ways to compensate for their ineptitude. Such an attitude disempowers patients and further disincentivizes their active participation in self-management—something increasingly recognized as essential to managing chronic disease (including resistant hypertension), as noted by the authors themselves. The risk profile the authors describe, being black, poor, low in
education, and high in depression, suggests that nonadherent hypertensive patients are already alienated. Physicians’ further disengagement from them in favor of technology will surely reinforce this sense of isolation and abandonment and only exacerbate their nonadherence. White coat hypertension, referred to throughout the article, is perhaps the clearest evidence of the powerful influence physicians can have on their patients. Physicians and their patients might be better served by articles investigating communication and motivational techniques that enable physicians to translate this influence into positive, patient-oriented outcomes, rather than touting unproven proprietary products (to which at least one of the authors of this article has ties) and ignoring the relational and behavioral aspects of medical care entirely.
Disclosures None. Benjamin A. Bensadon Department of Integrated Medical Sciences Charles E. Schmidt College of Medicine Florida Atlantic University Boca Raton, FL 1. Burnier M, Wuerzner G, Struijker-Boudier H, Urquhart J. Measuring, analyzing, and managing drug adherence in resistant hypertension. Hypertension. 2013;62:218–225.
(Hypertension. 2014;63:e7.) © 2013 American Heart Association, Inc. Hypertension is available at http://hyper.ahajournals.org
DOI: 10.1161/HYPERTENSIONAHA.113.02725
Downloaded from http://hyper.ahajournals.org/ by guest on May 17, 2015 e7
Maximizing Treatment Adherence: Physician−Patient Partnerships vs Procedures Benjamin A. Bensadon Hypertension. 2014;63:e7; originally published online December 23, 2013; doi: 10.1161/HYPERTENSIONAHA.113.02725 Hypertension is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2013 American Heart Association, Inc. All rights reserved. Print ISSN: 0194-911X. Online ISSN: 1524-4563
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://hyper.ahajournals.org/content/63/2/e7
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Hypertension can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Hypertension is online at: http://hyper.ahajournals.org//subscriptions/
Downloaded from http://hyper.ahajournals.org/ by guest on May 17, 2015
Maximizing Treatment Adherence: Physician– Patient Partnerships vs Procedures
In the August issue of Hypertension, Burnier et al1 open their review article with an encouragingly clear patient focus. They explicitly state effective hypertension management requires 2 types of patient behavior change: lifestyle modification and lifelong adherence to pharmacotherapy. The latter can work, they emphasize, “only if the patient is motivated to take the prescribed medication.” Yet, they fail to address further the critical role the physician should and must play in this process. In fact, the remainder of the article focuses entirely on poor drug adherence, without so much as mentioning lifestyle modification and patient motivation again. Although the authors recognize the challenge of psychosocial hurdles, they completely ignore behavioral interventions, turning instead to a series of therapeutic solutions such as avoiding medication entirely, and advocating investigative procedures whose efficacy, as the authors themselves acknowledge, is currently unproven. I believe this is not merely misguided, but represents precisely the wrong approach to recommend to physicians. It implies that patients are the problem because they cannot be trusted to take their medication and, as clinicians, we must find our own ways to compensate for their ineptitude. Such an attitude disempowers patients and further disincentivizes their active participation in self-management—something increasingly recognized as essential to managing chronic disease (including resistant hypertension), as noted by the authors themselves. The risk profile the authors describe, being black, poor, low in
education, and high in depression, suggests that nonadherent hypertensive patients are already alienated. Physicians’ further disengagement from them in favor of technology will surely reinforce this sense of isolation and abandonment and only exacerbate their nonadherence. White coat hypertension, referred to throughout the article, is perhaps the clearest evidence of the powerful influence physicians can have on their patients. Physicians and their patients might be better served by articles investigating communication and motivational techniques that enable physicians to translate this influence into positive, patient-oriented outcomes, rather than touting unproven proprietary products (to which at least one of the authors of this article has ties) and ignoring the relational and behavioral aspects of medical care entirely.
Disclosures None. Benjamin A. Bensadon Department of Integrated Medical Sciences Charles E. Schmidt College of Medicine Florida Atlantic University Boca Raton, FL 1. Burnier M, Wuerzner G, Struijker-Boudier H, Urquhart J. Measuring, analyzing, and managing drug adherence in resistant hypertension. Hypertension. 2013;62:218–225.
(Hypertension. 2014;63:e7.) © 2013 American Heart Association, Inc. Hypertension is available at http://hyper.ahajournals.org
DOI: 10.1161/HYPERTENSIONAHA.113.02725
Downloaded from http://hyper.ahajournals.org/ by guest on May 17, 2015 e7
Maximizing Treatment Adherence: Physician−Patient Partnerships vs Procedures Benjamin A. Bensadon Hypertension. 2014;63:e7; originally published online December 23, 2013; doi: 10.1161/HYPERTENSIONAHA.113.02725 Hypertension is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2013 American Heart Association, Inc. All rights reserved. Print ISSN: 0194-911X. Online ISSN: 1524-4563
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://hyper.ahajournals.org/content/63/2/e7
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Hypertension can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Hypertension is online at: http://hyper.ahajournals.org//subscriptions/
Downloaded from http://hyper.ahajournals.org/ by guest on May 17, 2015
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