HIGH COMPLIANCE RATE TO ANTIHYPERTENSIVE MEDICATIONS RECOMMENDED BY HYPERTENSION SPECIALIST IN A PRIVATE CLINIC – THE CASE STUDY OF SPIRONOACTONE

Objective: Despite a high number of available antihypertensive medications – the prevalence of uncontrolled hypertension is increasing worldwide. Non-adherence is a major cause for this “hypertension paradox”, and constitutes a serious challenge. Nonadherence is common among patients with resistant hypertension. When measured by indirect methods it reaches up to 20%, and by direct methods - up to 46% of the patients. We investigated adherence to spironolactone in a private hypertension consultant clinic, in which many patients present with either uncontrolled, resistant or refractory hypertension. We expected that adherence to the recommendation would be quite low, as the private clinic visit is not documented in the public healthcare organizations’ Electronic Health Records (EHR), and thus not easily accessible to the primary care physician (PCP). The patient has to visit the PCP with the recommendation summary in order to receive a prescription. Spironolactone adherence is challenging, as patients with resistant hypertension have a high pill burden. Its effect is relatively slow and adverse effects, especially among men (gynecomastia, loss of libido and sexual dysfunction) are substantial. Design and method: We searched 5 years of clinic records (2020-2024) for patients who received a recommendation for spironolactone, and found 105 patients. For those we recorded blood pressure at first visit, gender and age. We evaluated adherence for the first 5 months in which spironolactone was prescribed, and graded it as percentage according to months with a documented purchased prescription for spironolactone (0%- 100%). Results: Fifty-five patients (52%) were male. Median patient age was 70. Median Blood Pressure was 159/83.8 mmHg. We found no difference in adherence between sexes. When checked using Pearson correlation – adherence increased with age (P=0.034).Conclusions: Adherence to spironolactone was high and increased with age, contrary to expectations. There was no sex difference, despite the higher risk of adverse effects in men. These results are encouraging and might be attributed to patients’ trust and confidence in a highly specialized hypertension clinic. Further research is needed using direct measurement of adherence in multiple clinical settings.