Hypertension & patient noncompliance
Updated: Aug 22, 2022
My previous posts on hypertension and Ambulatory Blood Pressure Measurements (ABPM) and profiling focused on the technical capabilities of Biobeat’s revolutionary technologies. The next posts will shift from products to innovative solutions that target the most intractable barrier to reducing the prevalence of hypertension, patient noncompliance.
Hypertension is distinct as the silent killer that screams. The numbers (US) are staggering. It affects 115 million adults, over ten million who regularly see their doctors don’t know that they have it, millions more are misdiagnosed, 30% quit diagnostic protocols before completing them, and 50% stop taking their medicines within a year of diagnosis. Hypertension is a common comorbidity among patients with chronic and acute conditions; for example, it is the leading cause of strokes and recent studies connect it to higher death rates in Covid patients. The impacts are sobering as it was listed as a primary or secondary cause in 18% (~517,000) of reported deaths in the US alone (2019). So, why do patients seemingly ignore the obvious risks?
Patients are broadly framed in the medical literature as a special category of customers with limited options. This is reasonable for those experiencing life-altering events, life-threatening illnesses, and severe injuries. These situations guarantee collaboration. Hypertension, by contrast, is a broadly damaging, asymptomatic, and often difficult to control condition. Patients feel fine while the damage gradually mounts. In the short term, most will not feel better if their hypertension is brought under control. Conversely, patients experience immediate frustrations with time-consuming and uncomfortable diagnostic procedures, low treatment efficacy, lengthy searches for effective drug combinations, drug side effects, and related disruptions to their lives.
As a result, hypertension control protocols suffer from high diagnostic and treatment burdens, and research suggests that patients are very sensitive to such burdens. For example, researchers have found that simply increasing the number of medicines from one to two pills correlates with lower patient compliance. Taken together and viewed from decision-making frames of reference, existing hypertension control protocols make high rates of patient non-compliance predictable, despite the risks.
The central lessons for hypertension control programs, clinicians, and care providers are that to improve patient compliance, they must lower diagnostic and treatment burdens and increase patient engagement. Thankfully, innovative new technologies like Biobeat's ABPM can significantly reduce patient burdens, particularly when coupled with similarly innovative business models, as I’ll discuss in upcoming posts.