Interventions for Improving Adherence to the Treatment among Hypertensive Patients

Abstract

Introduction: To date, a little evidence such as systematic review and meta-analysis was conducted to evaluate the interventions that improve non-adherence to antihypertensive medications in hypertensive patients using. This review aimed to synthesize the data from these studies to provide a better understanding of non-adherence to antihypertensive medications in this population.
Methods: We selectively searched the PubMed database for publications on the treatment of hypertension that contained the terms "adherence," "drug," "treatment, "outcome," "hypertension," and "randomized controlled trial." Researchers conducted a search of several databases to identify studies published between 2000 and 2022 that measured self-reported adherence to antihypertensive medications in hypertensive patients. The final search results included 21 randomized controlled trials that examined the effect of various interventions on both blood pressure and adherence to medication in patients with hypertension. Many of these studies used multiple measures, or "complex interventions," to improve adherence. Blood pressure measurements were taken both in outpatient settings and in hospitals or doctors' offices.
Results: There is a wide range of interventions that have been studied to improve adherence to antihypertensive medications, including the use of calendar blister packs, combination preparations, patient education programs, personal encounters, and telephone-based computer systems. In 62% of the 21 randomized controlled studies that were identified, the interventions resulted in improved adherence, as measured by various methods including self-assessment, proportion of prescriptions filled, and electronic recording of medication intake. Improved adherence was generally associated with better clinical outcomes in hypertension, with effect sizes ranging from small to large. However, in 8 of the 21 studies, the interventions did not improve adherence. Pill counting is a simple method but does not provide information on timing of doses. MEMS caps can provide precise information on medication-taking patterns but may also cause hypotension and have not been extensively tested. HPLC-MS/MS can provide accurate measurements of medication in urine or serum but is expensive and may not accurately reflect long-term adherence.
Conclusions: Nonadherence to antihypertensive medications is common and can be difficult to accurately identify. Healthcare providers may underestimate nonadherence and self-report measures and questionnaires may be useful in understanding patient beliefs and barriers to adherence.