Low patient compliance (noncompliance) with hypertension protocols is widely reported as contributing to high rates of uncontrolled hypertension. In this context, patient medication nonadherence is usually the focal point of articles and discussions. Our investigations and analysis also consider patient engagement, collaboration, and compliance during the diagnostic process. Treatments can't begin until a proper diagnosis is completed.
Diagnostic non-compliance
Diagnostic noncompliance refers to the percentage of patients who quit, violate, and refuse diagnostic protocols. There are few studies that contextually quantify patient diagnostic noncompliance and the effects of legacy measuring devices (sphygmomanometers), including discomfort, inconvenience, and poor accuracy. Current practices recommend averaging three blood pressure readings taken at different times. Published papers also recommend having patients take and report their own readings so they can be averaged with those taken at their doctor’s office. As with other aspects of blood pressure, studies and recommendations vary[1],[2].
Patient compliance/noncompliance starts during diagnosis.
Our study concluded that about 20% of patients refuse, quit, and interfere
with legacy cuff-based diagnostic procedures.
The ‘golden standard’ for diagnosing hypertension has been legacy ambulatory blood pressure monitoring and profiling[3]. The legacy process involves a pressure cuff connected to a belt-mounted unit that inflates and effectively crushes the brachial artery four times an hour over twenty-four hours, a total of 96 compressions. The process can be bruising, uncomfortable, painful, and disruptive to sleep, leading many patients to reject, quit, and interfere with the measurements. A published research paper reported that patients subjected to legacy ABPM complained about being awakened during sleep (67%), cuff-site pain (32%), skin irritation (37%), and bruising (7%). Despite their volunteer participation and engagement with the study team, approximately 9% removed their monitor at some point during the night[4].
Reports from clinics in Israel suggest that about 30% of patients remove their cuff during legacy ABPM blood pressure profiling. Other published studies estimated that about 10% remove the cuff at one or more points during ABPM sessions. Feedback received during our presentations suggested that 20-25% of patients removed their cuffs and refused to participate in additional ABPM profiling despite their doctors’ recommendations.
Based on the above, our conservative estimate is that 20% of patients quit, violate, and refuse legacy diagnostic protocols.
References
[1] Laura Williamson, Blood pressure measurements in the clinic may vary widely between doctor's visits, American Heart Association News, March 8, 2023, American Heart Association, https://www.heart.org/en/news/2023/03/08/blood-pressure-measurements-in-the-clinic-may-vary-widely-between-doctors-visits [2] Eguchi K, Kuruvilla S, Ogedegbe G, Gerin W, Schwartz JE, Pickering TG. What is the optimal interval between successive home blood pressure readings using an automated oscillometric device? J Hypertens. 2009 Jun;27(6):1172-7. doi: 10.1097/hjh.0b013e32832a6e39. PMID: 19462492; PMCID: PMC2941726. [3] O'Brien E, White WB, Parati G, Dolan E. Ambulatory blood pressure monitoring in the 21st century. J Clin Hypertens (Greenwich). 2018 Jul;20(7):1108-1111. doi: 10.1111/jch.13275. PMID: 30003702; PMCID: PMC8030771. [4] Anthony J Viera, Kara Lingley, Alan L Hinderliter, Tolerability of the Oscar 2 ambulatory blood pressure monitor among research participants: a cross-sectional repeated measures study, April 27, 2011, BMC-Springer, https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-11-59