Non-adherence of antihypertensive therapy: A serious public health issue in Sri Lanka

Hypertension is the commonest risk factor for the most of the common causes of death in Sri Lanka; coronary heart disease, stroke, heart and renal failure. Nearly one-fifth to one-third of adult Sri Lankans have blood pressure levels that are above normal and the prevalence is comparable to those in the developed countries.1, 2, 3 The problem of hypertension is further compounded by the underuse of effective and generallywell tolerated antihypertensive medications. A large study carried out in the Gampaha district showed that 31.8% of patients had undetected hypertension and of the diagnosed hypertensives 19.5% were not on any medications. Only about 32.1% had optimal blood pressure control.3 Among hypertensive patients attending cardiology unit of National Hospital Colombo uncontrolled hypertension was present in 41.1% of the patients and 19.1% of them had resistant hypertension.4 The data available from the recent yet unpublished studies indicate that sub-optimal blood pressure control is a serious public health issue in Sri Lanka. It has been shown that 50% of individuals discontinue antihypertensive drugs within 6 to 12 months of their initiation.5 A multicenter observational study of blood pressure control among clinic attendees done in Colombo, Galle and Kandy showed that only 22% achieved a blood pressure target of less than 140/90 mmHg.6