Reasons for antihypertensive medication nonadherence influence physician preferences for hypertension management

Background/Introduction Patient nonadherence to prescribed antihypertensive medications is a major contributor to low global hypertension control rates. Attitudes toward renal denervation vary between physicians and patients, with recent data showing that side effects from medications is a key factor influencing both patient nonadherence to prescribed medications and preferences for interventional treatment. The influence of patient nonadherence on physician recommendations for renal denervation is not well understood. Purpose To examine whether specific reasons for patient nonadherence influence physician preferences for renal denervation as a treatment option for hypertension. Methods Online surveys were fielded to general and interventional cardiologists in Europe and the United States. Physicians were asked to position their willingness to recommend renal denervation in the hypertension management pathway based on three factors of nonadherence: patients' preference not to take antihypertensive medications, medication side effects, and nonspecific nonadherence to medication. The surveys followed the highest industry standards ISO 20252. Results were compared using two-tailed Z tests. Results Over two-thirds of 501 physicians surveyed stated that they would recommend renal denervation for uncontrolled hypertension irrespective of the reason for nonadherence. This recommendation was significantly more common in the scenario of patient reported medication side effects as compared with desire not to take medications or other nonspecific reasons for nonadherence (p<0.001 for both; Figure) Conclusions Surveyed physicians were more likely to recommend renal denervation to patients reporting side effects with their antihypertensive medications than for other reasons of nonadherence. These findings underscore the influence of patient-specific reasons for medication nonadherence on provider recommendations as part of a shared decision-making process when evaluating different options for hypertension management. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medtronic