Intentional and Unintentional Nonadherence to

Hypertension is a major modifiable risk factor for manycardiovascular problems such as coronary heart disease, myocardial infarction, congestive heart failure, stroke, and renal insufficiency.1,2 The prevalence of hypertension in the US has increased by 30 % in the last 10 years, to at least 65 million Americans.3 Although clinical trials have demon-strated the efficacy of antihypertensive medications in re-ducing blood pressure, fewer than one-third of patients re-ceiving treatment for hypertension have adequately con-trolled blood pressure.4 One likely explanation for the lack of effectiveness of hypertension control is nonadherence to treatment. Studies have indicated that roughly half of patients who use drug therapy to treat hypertension discontinue use within one year.5,6 Of patients who demonstrate poor blood pressure control, approximately 50 % do not adhere to their medica-tion as recommended by their healthcare provider.7 While drug adherence has traditionally been defined as an overall concept, findings have suggested that intentional and unintentional nonadherence should be recognized as