Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings
Why the study?
Do interventions to increase adherence improve medication adherence and blood pressure control in adults with essential hypertension in primary care?
Population
15,519 adults with essential hypertension in primary care across 38 RCTs
Comparison
Interventions to increase adherence to blood… vs Standard care or control groups as defined by…
Design
Systematic_review
Follow-up
2 to 60 months
Authors
Discussion
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Member takes
Implication
Prioritize simplified dosing regimens first-line in hypertension care; confirms RCT benefits over education alone.
Key Points
- To assess the effectiveness of various interventions designed to improve adherence to blood pressure-lowering medication in adults with high blood pressure treated in ambulatory care.
- Systematic search across CCTR, MEDLINE, EMBASE, and CINAHL up to April 2002 for randomized controlled trials targeting medication adherence and blood pressure control in adults with essential hypertension.
- Included 38 randomized controlled trials evaluating 58 interventions across nine countries from 1975 to 2000, encompassing 15,519 patients with follow-up durations between two and 60 months.
- Data extraction and quality assessment were conducted independently in duplicate following Cochrane Collaboration guidelines, without meta-analytic pooling due to substantial heterogeneity.
- Simplifying dosing regimens increased medication adherence in seven of nine studies, achieving relative increases between 8% and 19.6%.
- Motivational strategies improved adherence in 10 of 24 studies with relative increases up to 23%, whereas complex multicomponent interventions succeeded in eight of 18 studies with increases between 5% and 41%.
- Patient education delivered alone was largely ineffective across evaluated trials, and evidence linking improved adherence directly to blood pressure reduction remained limited.
Structured PICO
Do interventions to increase adherence improve medication adherence and blood pressure control in adults with essential hypertension in primary care?
P
Population
15,519 adults with essential hypertension in primary care across 38 RCTs
I
Intervention
Interventions to increase adherence to blood pressure lowering medication (including simplifying dosing regimens, motivational strategies, complex interventions, and patient education)
C
Comparator
Standard care or control groups as defined by individual RCTs
O
Outcome
Adherence to medication and blood pressure controlsurrogate
Simplifying dosing regimens is an effective first-line strategy to improve adherence to antihypertensive medications, whereas patient education alone is largely ineffective.
Limitations
- Heterogeneity between studies in terms of interventions and methods used to measure adherence prevented pooling of results
Cite This Study
Schroeder et al. (2004) studied this question.