Electronic Pill-Box Identifies Noncompliance That Doctors Miss
Research Presented At The Annual American Society Of Hypertension Meeting
New York, May 21, 1999--Michel Burnier, M.D., Professor of Medicine at the University of Lausanne, Switzerland, today presented research findings at the American Society of Hypertension annual meeting indicating that noncompliance with prescribed antihypertensive drugs is responsible for approximately half the failures of drug treatment to bring high blood pressure down to normal levels.
Hypertension affects one out of four American adults and is a leading cause of heart disease and stroke. High blood pressure can usually be controlled by various types of antihypertensive drugs, provided that they are taken correctly, yet failure of prescribed drugs to control blood pressure is a frequently occurring problem in treating hypertension. While it is well known that patient noncompliance interferes with effective drug action, new findings by Dr. Burnier show that clinically unrecognized noncompliance is responsible for approximately half the cases of uncontrolled hypertension. Positive identification of noncompliance was made by use of a special electronic medication container, called the eDEM Monitor.
"Without the electronic measure of each patient's drug intake, it is impossible on clinical grounds alone to identify whether a patient is taking the prescribed medicine correctly," said Dr. Burnier. "When treatment fails to control the blood pressure, a stronger medicine should be prescribed, but if the patient is not complying properly, prescribing a stronger medicine is pointless and costly. Until we had the electronic monitor, most cases of noncompliance went undetected and stronger drugs were mistakenly prescribed. Now we not only identify noncompliance, but we also have data on patients' daily dosing patterns. That is essential information for helping patients achieve good compliance and full benefits of prescribed drugs, not only in hypertension, but in other chronic diseases."
For two months, Dr. Burnier and his team monitored the dosing patterns and blood pressure levels of 29 patients with persistent hypertension, despite the prescription of usually effective drugs. The group consisted of five women and 24 men with a mean age of 49 years. During the study, each patient's compliance with the prescribed drug regimen was monitored via use of AARDEX's electronically monitored medication container, which recorded the time and date when the container was opened and closed, indicating that a dose had been taken. Patients were informed about the monitoring, and agreed to having it done. The research showed a strong link between lapses in dosing and increases in blood pressure, and overall there was a statistically significant inverse correlation between measured compliance and ambulatory diastolic blood pressure (r=0.37, p<0.05).
The eDEM Monitor, a medication package equipped with an electronic microchip, compiles the dosing histories of patients prescribed oral medications. The Monitor, developed by AARDEX Ltd., registers dosing times and dates. The data in the microchip are periodically transferred to a computer for analysis by the patients' caregivers.
The (Swiss) research team consisted of Drs. Burnier, M.P. Schneider, A. Chiolero, C.L. Fallab and H.R. Brunner, at the University of Lausanne Division of Hypertension.