Medication non-adherence and apparent treatment-resistant hypertension

Medication adherence refers to the extent to which a person's medication-taking behaviour corresponds with agreed recommendations from their clinician. Research shows that more than one-third of patients are non-adherent to their prescribed medications. Non-adherence is particularly significant in hypertension, as it complicates chronic disease management and may result in apparent treatment-resistant hypertension (aTRH), in which blood pressure remains uncontrolled despite appropriate pharmacological therapy and lifestyle measures. It is therefore important to assess adherence routinely, as non-adherence is one of the leading causes of aTRH. This article outlines a practical approach to recognising and assessing non-adherence using objective chemical adherence testing, and to managing medication non-adherence through non-judgemental, patient-centred discussion. Identifying non-adherence is vital, as failure to do so may lead to unnecessary treatment escalation, inappropriate investigations and avoidable healthcare costs, while addressing it can support and improve patient-centred outcomes.