Improving Therapeutic Adherence and Reducing Therapeutic Inertia in the Management of People with Cardiometabolic Diseases: A Call-to-Action from the Middle East

Overview

Journal Adv Ther

Date 2025 Jan 22

PMID 39841371

Authors

Wael Almahmeed

Zainab Alabadla

Fatheya Al Awadi

Dalal Alrohmaihi

Mostafa AlShamiri

Hussein Elbadawi

Hassan El-Tamimi

Abdel-Nasser Elzouki

Mohamed Farghaly

Khadija Hafidh

Mohamed Hassanein

Adel Khalifa Hamad

Kamlesh Khunti

Hani Sabbour

Aletta E Schutte

Affiliations

Soon will be listed here.

Abstract

Hypertension, dyslipidemia, and type 2 diabetes are highly prevalent and poorly controlled cardiometabolic diseases in the Middle East. Therapeutic non-adherence and therapeutic inertia are major contributors to this suboptimal disease control. Regardless of the cardiometabolic disease, evidence-based solutions may be used to improve therapeutic non-adherence and overcome inertia, and thereby help to alleviate the heavy burden of cardiovascular disease in the Middle East. Such solutions include the routine and early use of single-pill combinations, educational initiatives for patients, and multidisciplinary team-based care. This article highlights these and other potential solutions for therapeutic non-adherence and inertia, as discussed at the 2024 Evidence in the Cardiometabolic Environment (EVIDENT) Summit. There is now a 'call-to-action' from healthcare providers and other stakeholder groups to ensure that the solutions discussed at this meeting are implemented within health systems in the Middle East to significantly improve cardiovascular outcomes.Infographic available for this article.

References

Agarwal R, Bills J, Hecht T, Light R . Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis. Hypertension. 2010; 57(1):29-38. DOI: 10.1161/HYPERTENSIONAHA.110.160911. View

Lai X, Zhu H, Huo X, Li Z . Polypharmacy in the oldest old (≥80 years of age) patients in China: a cross-sectional study. BMC Geriatr. 2018; 18(1):64. PMC: 5834886. DOI: 10.1186/s12877-018-0754-y. View

Robberechts T, Stoenoiu M, Burnier M, Persu A . Optimizing drug adherence in hypertension: More than a mind game. Kardiol Pol. 2024; 82(3):259-266. DOI: 10.33963/v.phj.99493. View

Khunti K, Kosiborod M, Ray K . Legacy benefits of blood glucose, blood pressure and lipid control in individuals with diabetes and cardiovascular disease: Time to overcome multifactorial therapeutic inertia?. Diabetes Obes Metab. 2018; 20(6):1337-1341. DOI: 10.1111/dom.13243. View

. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021; 398(10304):957-980. PMC: 8446938. DOI: 10.1016/S0140-6736(21)01330-1. View

Visseren F, Mach F, Smulders Y, Carballo D, Koskinas K, Back M . 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021; 42(34):3227-3337. DOI: 10.1093/eurheartj/ehab484. View

Ray K, Reeskamp L, Laufs U, Banach M, Mach F, Tokgozoglu L . Combination lipid-lowering therapy as first-line strategy in very high-risk patients. Eur Heart J. 2021; 43(8):830-833. DOI: 10.1093/eurheartj/ehab718. View

Castellano J, Pocock S, Bhatt D, Quesada A, Owen R, Fernandez-Ortiz A . Polypill Strategy in Secondary Cardiovascular Prevention. N Engl J Med. 2022; 387(11):967-977. DOI: 10.1056/NEJMoa2208275. View

Matthews D, Del Prato S, Mohan V, Mathieu C, Vencio S, Chan J . Insights from VERIFY: Early Combination Therapy Provides Better Glycaemic Durability Than a Stepwise Approach in Newly Diagnosed Type 2 Diabetes. Diabetes Ther. 2020; 11(11):2465-2476. PMC: 7547931. DOI: 10.1007/s13300-020-00926-7. View

10.

Fitzpatrick C, Gillies C, Seidu S, Kar D, Ioannidou E, Davies M . Effect of pragmatic versus explanatory interventions on medication adherence in people with cardiometabolic conditions: a systematic review and meta-analysis. BMJ Open. 2020; 10(7):e036575. PMC: 7380877. DOI: 10.1136/bmjopen-2019-036575. View

11.

Polonsky W, Capehorn M, Belton A, Down S, Alzaid A, Gamerman V . Physician-patient communication at diagnosis of type 2 diabetes and its links to patient outcomes: New results from the global IntroDia® study. Diabetes Res Clin Pract. 2017; 127:265-274. DOI: 10.1016/j.diabres.2017.03.016. View

12.

Olsen M, Angell S, Asma S, Boutouyrie P, Burger D, Chirinos J . A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. Lancet. 2016; 388(10060):2665-2712. DOI: 10.1016/S0140-6736(16)31134-5. View

13.

Nguyen E, Sobieraj D . The impact of appointment-based medication synchronization on medication taking behaviour and health outcomes: A systematic review. J Clin Pharm Ther. 2017; 42(4):404-413. DOI: 10.1111/jcpt.12554. View

14.

Ray K, Molemans B, Schoonen W, Giovas P, Bray S, Kiru G . EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study. Eur J Prev Cardiol. 2021; 28(11):1279-1289. DOI: 10.1093/eurjpc/zwaa047. View

15.

Vrijens B, de Geest S, Hughes D, Przemyslaw K, Demonceau J, Ruppar T . A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012; 73(5):691-705. PMC: 3403197. DOI: 10.1111/j.1365-2125.2012.04167.x. View

16.

Sabahi A, Jalali S, Ameri F, Garavand A, Negahban A . The effect of using mobile health on self-management of type 2 diabetic patients: A systematic review in Iran. J Educ Health Promot. 2023; 12:358. PMC: 10743845. DOI: 10.4103/jehp.jehp_910_22. View

17.

Hunt J, Siemienczuk J, Pape G, Rozenfeld Y, MacKay J, LeBlanc B . A randomized controlled trial of team-based care: impact of physician-pharmacist collaboration on uncontrolled hypertension. J Gen Intern Med. 2008; 23(12):1966-72. PMC: 2596500. DOI: 10.1007/s11606-008-0791-x. View

18.

Bolen S, Samuels T, Yeh H, Marinopoulos S, McGuire M, Abuid M . Failure to intensify antihypertensive treatment by primary care providers: a cohort study in adults with diabetes mellitus and hypertension. J Gen Intern Med. 2008; 23(5):543-50. PMC: 2324132. DOI: 10.1007/s11606-008-0507-2. View

19.

Unger T, Borghi C, Charchar F, Khan N, Poulter N, Prabhakaran D . 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertens. 2020; 38(6):982-1004. DOI: 10.1097/HJH.0000000000002453. View

20.

Fang M, Wang D, Coresh J, Selvin E . Trends in Diabetes Treatment and Control in U.S. Adults, 1999-2018. N Engl J Med. 2021; 384(23):2219-2228. PMC: 8385648. DOI: 10.1056/NEJMsa2032271. View