Systematic review of motivational interventions to improve adherence to medication in patients with hypertension and meta-analysis

Impact of blood pressure and medication adherence on clinical outcomes in patients with hypertension

Background

Hypertension is a key risk factor for cardiovascular disease. Thus, effective blood pressure (BP) management and adherence to antihypertensive medications are crucial for reducing these risks in patients with hypertension. We evaluated the effect of BP and medication adherence on the clinical outcomes of patients with hypertension.

Methods

This is retrospective cohort study utilized data from the Korean National Health Insurance Database. We analyzed data from 238,950 patients with hypertension aged ≥20 who underwent at least two health checkups between 2009 and 2012. Patients were categorized according to their systolic BP (SBP) and medication adherence. The primary outcome was a composite of all-cause death, myocardial infarction, ischemic stroke, hemorrhagic stroke, and hospitalization for heart failure. Cox proportional hazard models were used to estimate hazard ratios (HR) for composite outcomes.

Results

Higher SBP groups were associated with increased risk of composite outcomes compared to the 120-129 mmHg group (<120 mmHg, HR 1.065; 130-139 mmHg, HR 1.056; 140-149 mmHg, HR 1.068; and ≥150 mmHg, HR 1.238). In addition, across all SBP categories, poor adherence significantly elevated the risk of composite outcomes, even after adjusting for confounding factors. Among all categories, patients with high SBP (≥150 mmHg) and poor adherence had the highest risk.

Conclusion

Higher SBP and poor medication adherence were independently associated with worse clinical outcomes in patients with hypertension. Strategies to enhance medication adherence and achieve optimal BP control are essential to reduce cardiovascular risk.

Adherence to pharmacological therapy for hypertension in Portugal: a health professionals focus groups study

INTRODUCTION

The perspectives of local healthcare professionals for developing effective strategies to enhance medication adherence in arterial Hypertension as well as its barriers have not yet been explored through qualitative research in Portugal.

OBJECTIVES

This study aimed to assess the views of healthcare professionals including general practitioners/family physicians, nurses, and community pharmacists, from Portugal on effective strategies to improve medication adherence in Hypertension, and to identify factors hindering pharmacological adherence.

METHODS AND ANALYSES

This was a qualitative study with synchronous online focus groups, in which, the participants were general practitioners/family physicians, family nurses, or community pharmacists in Portugal with experience managing patients with Hypertension. They were selected based on age, sex, and geographical region with the number of focus groups determined by theoretical saturation. Recruitment was facilitated through specific mailing lists. Purposive and snowball sampling techniques were employed. Focus group discussions were recorded and transcribed. Two researchers conducted content analyses via MAXQDA®2023, applying comparative analysis and reaching consensus. The results are described narratively.

RESULTS

Three focus group discussions revealed a multifaceted approach to improving medication adherence for Hypertension. Key strategies to enhance coordination and communication among healthcare professionals, patients, and caregivers were identified. These included shared informatics software among healthcare professionals; using mobile applications and wearables; health literacy initiatives and patient empowerment; preprepared medication in pillboxes; involving family and the concept of a "family pharmacist". Participants highlighted barriers to medication adherence such as the lack of communication with patients concerning issues like medication adherence.

CONCLUSIONS

This qualitative study outlines strategies to improve medication adherence among patients with Hypertension in Portugal. These involve improving healthcare coordination and communication, patient empowerment, and involving family and "family pharmacists" in supporting adherence. These strategies are based on the insights of healthcare professionals and could be implemented following robust intervention studies.

CLINICAL TRIAL NUMBER

Not applicable.

Adherence to pharmacological therapy in patients with hypertension: protocol of a qualitative study by focus groups

INTRODUCTION

Non-adherence to antihypertensive medication significantly contributes to inadequate blood pressure control. Regarding non-pharmacological interventions to improve medication adherence, the question remains of which interventions yield the highest efficacy.Understanding the complementary perspectives of patients and healthcare professionals can be valuable for designing strategies to enhance medication adherence. Few studies explored the perspectives of patients and healthcare professionals regarding medication adherence. None of them focused specifically on adherence to pharmacological therapy for hypertension in Portugal.Considering the high prevalence of non-adherence and its location-specific aspects, the priority should be identifying its barriers and developing tactics to address them.This study aims to gather the perspectives of patients with hypertension and healthcare professionals such as family doctors, nurses and community pharmacists from Portugal, regarding the most effective strategies to enhance antihypertensive medication adherence and to understand the factors contributing to non-adherence.

METHODS AND ANALYSES

We will conduct qualitative research through synchronous online focus groups of 6-10 participants. Some groups will involve patients with hypertension, while others will include family doctors, nurses and community pharmacists. The number of focus groups will depend on the achievement of theoretical saturation. A purposive sample will be used. Healthcare participants will be recruited via email, while patients will be recruited through their family doctors.The moderator will maintain neutrality while ensuring interactive contributions from every participant. Participants will be encouraged to express their opinions on the meeting summary. Meetings will be recorded and transcribed.Two researchers will perform content analyses using MAXQDA V.12 through comparative analyses and subsequent consensus. A third researcher will review the analyses. The results will be presented narratively.

ETHICS AND DISSEMINATION

The Ethics Committee of the University of Coimbra has approved this study with the number: CE-026/2021. The results will be disseminated via peer-reviewed publications and national and international conferences.