Nonadherence, Clinic Inertia, and Ineffective Adherence in Antihypertensive Treatment in Latin America

Arterial hypertension (HTN) is the leading modifiable risk factor for cardiovascular diseases in Latin America; however, control rates remain inadequate. Two primary contributors to this public health crisis are nonadherence to antihypertensive treatment and clinical inertia. Nonadherence rates in the region range from 14% to 94%, while clinical inertia, defined as healthcare providers' failure to escalate or modify treatment, when necessary, further complicates the issue. The interplay between these two factors creates a self-perpetuating cycle that leads to poorly controlled hypertension, increased morbidity and mortality, and a greater economic burden. A primary concern is "ineffective adherence", which occurs when patients follow prescribed treatments but do not achieve desired outcomes. This phenomenon is primarily driven by medical inertia and affects a significant proportion of cases. This review examines the scope of these issues in Latin America, their socioeconomic impacts, and potential interventions to mitigate their effects. To better manage hypertension, comprehensive strategies are recommended, including patient-centered interventions, education directed at providers, essential healthcare reforms, and team-based care strategies that involve non-physician providers.