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September 1, 1993American Journal of Hypertension

Antihypertensive Medication-Taking Investigation of a Simple Regimen

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Why the study?

Does electronic monitoring detect suboptimal medication compliance more accurately than pill counts in ambulatory hypertensives?

Population

19 ambulatory hypertensives, mean age 58.4 +/- 2.5 years, 79% male, 68% white, and 16% black.

Comparison

Electronic monitoring of medication-taking… vs Pill counts

Design

Cohort

Follow-up

< or = 63 weeks

Authors

DGDavid GuerreroUniversité Gustave EiffelPRPeter RuddRoyal Devon & Exeter NHS Foundation TrustCBC. Bryant-Kosling

Discussion

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Implication

Electronic monitoring may identify far more nonadherence than pill counts in hypertension; leaves open whether it improves outcomes.

Key Points

  • To evaluate medication-taking behavior and compliance rates for a once-daily antihypertensive regimen by comparing manual pill counts with electronic monitoring.
  • Monitored 19 ambulatory hypertensive adults (mean age 58.4 ± 2.5 years; 79% male, 68% white, 16% black) prescribed one pill daily for up to 63 weeks with return visits every 1 to 4 weeks.
  • Assessed medication-taking behavior simultaneously using traditional manual pill counts and electronic pill vial opening timestamps.
  • Only 51% of intervisit intervals met the desirable window of ≥ 80% vial openings occurring within 24 ± 6 hours.
  • Manual pill counts detected only 2% of the suboptimal interdosing intervals identified by electronic monitoring.
  • Early changes in compliance strongly correlated with later changes (r = 0.83, P = .002), with some subjects showing large deviations from prescribed regimens.

Structured PICO

Does electronic monitoring detect suboptimal medication compliance more accurately than pill counts in ambulatory hypertensives?

P
Population
19 ambulatory hypertensives, mean age 58.4 +/- 2.5 years, 79% male, 68% white, and 16% black.
I
Intervention
Electronic monitoring of medication-taking behavior for a simple antihypertensive regimen (one pill each day for <= 63 weeks).
C
Comparator
Pill counts
O
Outcome
Medication compliance (percentage of intervisit intervals displaying >= 80% of vial openings within the desirable range of 24 +/- 6 hours).

Electronic monitoring reveals that traditional pill counts vastly overestimate medication compliance in hypertensive patients, and early compliance patterns strongly predict long-term adherence.

Cite This Study

Guerrero et al. (1993) studied this question.

synapsesocial.com/papers/6a8a5f1a1fb56efa37d49791https://doi.org/10.1093/ajh/6.7.586

Topics

Hypertension management
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The natural history of medication compliance in a drug trial: Limitations of pill counts1989 · 206 citations
  2. 2Assessing Medication Adherence Simultaneously by Electronic Monitoring and Pill Count in Patients With Mild-to-Moderate Hypertension2009 · 80 citations
  3. 3Validation of Patient Reports, Automated Pharmacy Records, and Pill Counts With Electronic Monitoring of Adherence to Antihypertensive Therapy1999 · 548 citations
  4. 4IMPROVED BLOOD PRESSURE CONTROL BY MONITORING COMPLIANCE WITH ANTIHYPERTENSIVE THERAPY1999 · 50 citations
  5. 5Use of electronic pill boxes to assess risk of poor treatment compliance Results of a large-scale trial1999 · 53 citations