1. Adherence and persistence with medication regimens is highly relevant to disease outcomes

2. Adherence to a medication regimen is generally defined as the extent to which patients take medications as prescribed by their health care provider. 1 1. Osterberg L, Blasche T. N Engl J Med. 2005;353:487-497. 2. Breekveldt-Postma NS et al. Curr Med Res Opin. 2008;24:121-127. Nonpersistence with antihypertensive therapy is associated with an increased risk of myocardial infarction and stroke. 2 Methods that can be used to confirm adherence to a medication regimen include: monitoring of pill count, monitoring of prescription refill rate, and patient use of “smart” pill bottles, but these are all indirect measures.

3. * Defined as the total number of days of therapy for medication dispensed/365 days of study follow-up ACE, angiotensin-converting enzyme; CCB, calcium channel blocker; SPC, single-pill combination Gerbino PP, Shoheiber O. Am J Health System Pharm. 2007;64:1279-1283. SPC (ACE inhibitor + CCB) (n=2839) Free combination (ACE inhibitior + CCB) (n=3367) Medication possession ratio (MPR) * P<0.0001 88% 69% 0%20%40%60%80%100% Prescription of a single-pill combination is associated with improved adherence rates compared with free-combination therapy

4. A new device* approved by the FDA 1 can be included in antihypertensive pills to monitor the adherence to treatment The ingestible sensor is made entirely of ingredients found in food and is activated upon ingestion to transmit a unique number which is captured by an external patch. The ingestible sensor does not require any battery or antenna; it is powered by the contact with stomach fluids. The ingestible sensor can be embedded in a drug product and can be used for directly confirming medication adherence, as part of a networked wellness system. Edible sensor attached directly to a tablet The networked system has already been tested in hypertension and heart failure populations. * The Ingestion Event Marker (IEM), by Proteus Health. 1. FDA approves digestible microchips to be placed in pills. Medscape. August 3, 2012.