The Heart of the Matter

Feb 14, 2013
Cardiovascular patients have unique barriers to Rx adherence. But specialist pharmacists can help them maintain a lasting relationship with their therapy.
  • High Blood Cholesterol
  • High Blood Pressure/Heart Disease

Valentine’s Day comes once a year, but Express Scripts cardiovascular specialist pharmacists play Cupid every day by making sure patients have a lasting relationship with their medication.

One in six Americans has high cholesterol and nearly one-third of American adults – 76 million individuals – have hypertension or high blood pressure. Both are conditions that can cause long-term damage to the heart and other organs.

High cholesterol and high blood pressure usually do not have any visible symptoms. Unfortunately, many patients learn they have these conditions only after they suffer a cardiac event.

Fortunately, there are many effective and affordable medications to treat high cholesterol, high blood pressure and heart disease. These conditions are a leading driver of traditional drug spend. But nonadherence is high: According to the Express Scripts Drug Trend Report, 31% of hypertension patients and 29% of high cholesterol patients are nonadherent.

Forgetfulness plays a role in nonadherence, but patients with cardiovascular conditions have other specific clinical barriers that our specialist pharmacists are in a unique position to recognize and address.

While many cases of high blood pressure and high cholesterol are related to lifestyle and diet, for some patients, the conditions are due to genetic factors that they cannot completely solve for with lifestyle modifications. Medication adherence can help patients reach their therapy goal.

One Barrier to Adherence: Misunderstanding How Medication Works

We frequently encounter patients who check their blood pressure every day and only take their medication if their blood pressure is above goal. They don’t realize that if they stop using their medication, their pressure will go back up.

Our specialist pharmacists also encounter patients with high cholesterol who only take their statin medication when they eat something unhealthy, thinking that the medication would simply “erase” the bad food choice.

Another Barrier to Adherence: Side Effects

Because patients don’t usually experience symptoms from high blood pressure or high cholesterol, the side effects of a new medication can be especially discouraging.

Patients with hypertension and congestive heart failure often are prescribed a diuretic, or water pill, to diminish fluid retention and reduce the workload on the heart. It is imperative that these patients take this medication every day and weigh themselves every morning to make sure they are not retaining too much fluid.

One side effect of this medication is frequent urination, which can be inconvenient and impede adherence.

This common side effect happens when a patient first begins the medication, but after a few weeks of continued use, this side effect usually disappears. In this case, being nonadherent actually makes the side effect worse; remaining adherent will help the patient overcome the side effect more quickly.

Why Specialists Pharmacists Are Critical to Long-Term Heart Health

Specialist pharmacists in our Cardiovascular Therapeutic Resource Center have years of experience focusing their work on managing patients with these conditions. When a clinical barrier is present that can sabotage a patient’s good intentions to stay on essential therapy, our cardiovascular specialist pharmacists are uniquely qualified to address the barrier and to guide the patient toward better decisions when it comes to medication adherence.

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