Strategies to Enhance Compliance with Treatment in Patients with Hypertension

Abstract

Introduction:

Limited evidence from systematic reviews and meta-analyses exists on the effectiveness of interventions aimed at improving poor compliance with antihypertensive drugs among patients with hypertension. This review seeks to consolidate findings from these analyses to better comprehend the issues surrounding medication non-compliance in this demographic.

Methods:

An exclusive search was conducted in the PubMed database for studies on hypertension management featuring keywords such as "adherence," "drug," "treatment," "outcome," "hypertension," and "randomized controlled trial." A comprehensive search across various databases was performed to identify research published from 2000 to 2022 that focused on self-reported medication adherence among individuals with hypertension. The search yielded 21 randomized controlled trials that evaluated the impact of different interventions on both blood pressure control and medication adherence in hypertensive patients. These studies often implemented complex interventions to enhance adherence, with blood pressure measurements recorded in both outpatient and clinical settings.

Results:

A variety of strategies have been explored to boost compliance with antihypertensive medication, including calendar blister packs, combination drug formulations, educational initiatives for patients, direct interactions, and telephonic computer systems. In 62% of the 21 identified randomized controlled trials, these interventions led to significant improvements in adherence, gauged through methods such as self-reports, prescription refill rates, and electronic monitoring of drug intake. Generally, better adherence correlated with improved hypertension management outcomes, with the magnitude of effects varying. Nevertheless, in 8 out of the 21 studies, no enhancement in adherence was observed. While pill counting is straightforward, it fails to capture the timing of medication intake. MEMS caps can detail medication-taking behavior but might induce hypotension without thorough validation. HPLC-MS/MS offers precise drug concentration measurements in biological fluids but is costly and might not reliably indicate long-term compliance.

Conclusions:

Noncompliance with antihypertensive medication is widespread and challenging to precisely detect. Health practitioners may not fully recognize the extent of nonadherence, and self-reported measures along with questionnaires could play a crucial role in identifying patient attitudes and obstacles to following prescribed treatment regimes.