In adults with hypertension, dosing of antihypertensive medication once daily rather than multiple times daily is beneficial to improve adherence.S12.1.1-1 S12.1.1-3 IIa B-NR 2. Use of combination pills rather than free individual components can be useful to improve adherence to antihypertensive Synopsis Up to 25% of patients do not fill their initial prescription for During the first year of treatment, the average patient has possession of antihyperten- sive medications only 50% of the time, and only 1 in 5 patients has sufficiently high adherence to achieve the benefits observed in clinical trials.S12.1.1-11,S12.1.1-12 Factors contributing to poor adherence are myriad, com- plex, and multilevel.S12.1.1-11,S12.1.1-13,S12.1.1-14 Therefore, solu- tions to improve adherence may be introduced at patient, provider, and healthcare system levels.S12.1.1-13,S12.1.1-15,S12.1.1-16 Several systematic reviews and meta-analyses have assessed the impact of interventions on adherence to antihyperten- sive medications, including modification of antihypertensive No single inter- vention is uniquely effective, and a sustained, coordinated effort that targets all barriers to adherence in an individual is likely to be the most effective approach. See Online Data Supplement F for barriers to medication adherence and the most successful interventions. The creation of an encouraging, blame-free environment in which patients are recognized for achieving treatment goals and given permission to answer questions related to their treatment honestly is essential to identify and address nonad- herence. Patient medication adherence assessment toolsS12.1.1-17 are presented in Online Data Supplement A. Members of the hypertension care team may use these self-report tools in a nonthreatening fashion to identify barriers and facilitate behaviors associated with improved adherence to antihyper- tensive medications. Use of more objective methods (eg, pill counts, data on medication refills) to assess adherence along with self-report methods is optimal. Recommendation-Specific Supportive Text 1. 