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Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis

  • Prevention of Hypertension: Public Health Challenges (P Muntner, Section Editor)
  • Published:
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Abstract

This systematic review applied meta-analytic procedures to synthesize medication adherence interventions that focus on adults with hypertension. Comprehensive searching located trials with medication adherence behavior outcomes. Study sample, design, intervention characteristics, and outcomes were coded. Random-effects models were used in calculating standardized mean difference effect sizes. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression to explore associations between effect sizes and sample, design, and intervention characteristics. Effect sizes were calculated for 112 eligible treatment-vs.-control group outcome comparisons of 34,272 subjects. The overall standardized mean difference effect size between treatment and control subjects was 0.300. Exploratory moderator analyses revealed interventions were most effective among female, older, and moderate- or high-income participants. The most promising intervention components were those linking adherence behavior with habits, giving adherence feedback to patients, self-monitoring of blood pressure, using pill boxes and other special packaging, and motivational interviewing. The most effective interventions employed multiple components and were delivered over many days. Future research should strive for minimizing risks of bias common in this literature, especially avoiding self-report adherence measures.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. CDC. High blood pressure fact sheet. In: National Center for Chronic Disease Prevention and Health Promotion DfHDaSP, editor.: Centers for Disease Control and Prevention. 2015.

  2. Burnier M. Managing ‘resistance’: is adherence a target for treatment? Curr Opin Nephrol Hypertens. 2014;23:439–43. This paper documents the importance of inadequate medication adherence in resistant hypertension.

  3. Christensen A, Osterberg LG, Hansen EH. Electronic monitoring of patient adherence to oral antihypertensive medical treatment: a systematic review. J Hypertens. 2009;27:1540–51.

    Article  CAS  PubMed  Google Scholar 

  4. De Geest S, Ruppar T, Berben L, Schonfeld S, Hill MN. Medication non-adherence as a critical factor in the management of presumed resistant hypertension: a narrative review. EuroIntervention. 2014;9:1102–9. This article explains the role of nonadherence to medications in resistant hypertension.

  5. Erdine S, Arslan E. Monitoring treatment adherence in hypertension. Curr Hypertens Rep. 2013;15:269–72.

    Article  CAS  PubMed  Google Scholar 

  6. Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, et al. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006;333:15.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Wofford MR, Minor DS. Hypertension: issues in control and resistance. Curr Hypertens Rep. 2009;11:323–8.

    Article  PubMed  Google Scholar 

  8. Vrijens B, Vincze G, Kristanto P, Urquhart J, Burnier M. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ. 2008;336:1114–7.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Jung O, Gechter JL, Wunder C, Paulke A, Bartel C, Geiger H, et al. Resistant hypertension? Assessment of adherence by toxicological urine analysis. J Hypertens. 2013;31:766–74.

    Article  CAS  PubMed  Google Scholar 

  10. Dragomir A, Cote R, Roy L, Blais L, Lalonde L, Berard A, et al. Impact of adherence to antihypertensive agents on clinical outcomes and hospitalization costs. Med Care. 2010;48:418–25. This study linked hypertensive medication adherence with vascular events, hospitalizations, and costs of healthcare.

  11. Gwadry-Sridhar FH, Manias E, Lal L, Salas M, Hughes DA, Ratzki-Leewing A, et al. Impact of interventions on medication adherence and blood pressure control in patients with essential hypertension: a systematic review by the ISPOR medication adherence and persistence special interest group. Value Health. 2013;16:863–71.

    Article  PubMed  Google Scholar 

  12. Bramlage P, Hasford J. Blood pressure reduction, persistence and costs in the evaluation of antihypertensive drug treatment—a review. Cardiovasc Diabetol. 2009;8:18.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  13. Lewis LM. Factors associated with medication adherence in hypertensive blacks: a review of the literature. J Cardiovasc Nurs. 2012;27:208–19.

    Article  PubMed  Google Scholar 

  14. Lewis LM, Ogedegbe C, Ogedegbe G. Enhancing adherence of antihypertensive regimens in hypertensive African-Americans: current and future prospects. Expert Rev Cardiovasc Ther. 2012;10:1375–80.

    Article  CAS  PubMed  Google Scholar 

  15. Matthes J, Albus C. Improving adherence with medication: a selective literature review based on the example of hypertension treatment. Deutsches Arzteblatt Int. 2014;111:41–7.

    Google Scholar 

  16. Takiya LN, Peterson AM, Finley RS. Meta-analysis of interventions for medication adherence to antihypertensives. Ann Pharmacother. 2004;38:1617–24.

    Article  PubMed  Google Scholar 

  17. Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev. 2010;3, CD005182. doi:10.1002/14651858.CD005182.pub4.

    PubMed  Google Scholar 

  18. Jayasinghe J. Non-adherence in the hypertensive patient: can nursing play a role in assessing and improving compliance? Can J Cardiovasc Nurs. 2009;19:7–12.

    PubMed  Google Scholar 

  19. Morgado MP, Morgado SR, Mendes LC, Pereira LJ, Castelo-Branco M. Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: review and meta-analysis. Am J Health Syst Pharm. 2011;68:241–53.

    Article  PubMed  Google Scholar 

  20. Cooper H, Hedges LV, Valentine JC, editors. The handbook of research synthesis and meta-analysis. 2nd ed. New York: Russell Sage; 2009.

    Google Scholar 

  21. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62:e1–34.

    Article  PubMed  Google Scholar 

  22. World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.

    Google Scholar 

  23. Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012;73:691–705.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Borenstein M, Hedges L, Higgins JPT, Rothstein H. Introduction to meta-analysis. West Sussex: Wiley; 2009.

    Book  Google Scholar 

  25. Sutton AJ. Publication bias. In: Cooper H, Hedges L, Valentine J, editors. The handbook of research synthesis and meta-analysis. 2nd ed. New York: Russell Sage; 2009. p. 435–52.

    Google Scholar 

  26. Rothstein HR, Hopewell S. Grey literature. In: Cooper H, Hedges L, Valentine J, editors. The handbook of research synthesis and meta-analysis. 2nd ed. New York: Russell Sage; 2009. p. 103–25.

    Google Scholar 

  27. White H. Scientific communication and literature retrieval. In: Cooper H, Hedges L, Valentine J, editors. The handbook of research synthesis and meta-analysis. 2nd ed. New York: Russell Sage; 2009. p. 51–71.

    Google Scholar 

  28. Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. BMJ. 1994;309:1286–91.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Stern JM, Simes RJ. Publication bias: evidence of delayed publication in a cohort study of clinical research projects. BMJ. 1997;315:640–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Easterbrook PJ. Directory of registries of clinical trials. Stat Med. 1992;11:363–423.

    Article  CAS  PubMed  Google Scholar 

  31. Langham J, Thompson E, Rowen K. Identification of randomized controlled trials from the emergency medicine literature: comparison of hand searching versus MEDLINE searching. Ann Emerg Med. 1999;34:25–34.

    Article  CAS  PubMed  Google Scholar 

  32. Wood JA. Methodology for dealing with duplicate study effects in a meta-analysis. Orgn Res Methods. 2008;11:79–95.

    Article  Google Scholar 

  33. Devine E. Issues and challenges in coding interventions for meta-analysis of prevention research. Meta-analysis of drug abuse prevention programs. Rockville: National Institute on Drug Abuse; 1997.

    Google Scholar 

  34. Orwin R, Vevea J. Evaluating coding decisions. In: Cooper H, Hedges L, Valentine J, editors. The handbook of research synthesis and meta-analysis. 2nd ed. New York: Russell Sage; 2009. p. 177–203.

    Google Scholar 

  35. Lipsey M, Wilson D. Practical meta-analysis. Thousand Oaks: Sage; 2001.

    Google Scholar 

  36. Raudenbush S. Random effects models. In: Cooper H, Hedges L, Valentine J, editors. The handbook of research synthesis and meta-analysis. 2nd ed. New York: Russell Sage; 2009. p. 295–315.

    Google Scholar 

  37. Hedges L, Vevea J. Fixed- and random-effects models in meta-analysis. Psychol Methods. 1998;3:486–504.

    Article  Google Scholar 

  38. Hedges L, Olkin I. Statistical methods for meta-analysis. Orlando: Academic; 1985.

    Google Scholar 

  39. Conn VS, Hafdahl AR, Mehr DR, LeMaster JW, Brown SA, Nielsen PJ. Metabolic effects of interventions to increase exercise in adults with type 2 diabetes. Diabetologia. 2007;50:913–21.

    Article  CAS  PubMed  Google Scholar 

  40. Shadish W, Haddock C. Combining estimates of effect size. In: Cooper H, Hedges L, Valentine J, editors. The handbook of research synthesis and meta-analysis. 2nd ed. New York: Russell Sage; 2009. p. 257–77.

    Google Scholar 

  41. Nony P, Cucherat M, Haugh MC, Boissel JP. Critical reading of the meta-analysis of clinical trials. Therapie. 1995;50:339–51.

    CAS  PubMed  Google Scholar 

  42. Helmer D, Savoie I, Green C, Kazanjian A. Evidence-based practice: extending the search to find material for the systematic review. Bull Med Libr Assoc. 2001;89:346–52.

    PubMed Central  CAS  PubMed  Google Scholar 

  43. Conn VS, Rantz MJ. Research methods: managing primary study quality in meta-analyses. Res Nurs Health. 2003;26:322–33.

    Article  PubMed  Google Scholar 

  44. de Vet HC, de Bie RA, van der Heijden GJ, Verhagen AP, Sijpkes P, Kipschild P. Systematic review on the basis of methodological criteria. Physiotherapy. 1997;1997:284–9.

    Article  Google Scholar 

  45. Valentine J. Judging the quality of primary research. In: Cooper H, Hedges L, Valentine J, editors. The handbook of research synthesis and meta-analysis. 2nd ed. New York: Russell Sage; 2009. p. 129–46.

    Google Scholar 

  46. Adeyemo A, Tayo BO, Luke A, Ogedegbe O, Durazo-Arvizu R, Cooper RS. The Nigerian antihypertensive adherence trial: a community-based randomized trial. J Hypertens. 2013;31:201–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  47. Aguwa CN, Ukwe CV, Ekwunife OI. Effect of pharmaceutical care programme on blood pressure and quality of life in a Nigerian pharmacy. Pharm World Sci. 2008;30:107–10.

    Article  PubMed  Google Scholar 

  48. Al Owaish RA. Compliance with, and effectiveness of, specialized care of hypertension in Kuwait [dissertation]. Chapel Hill, NC: University of North Carolina; 1985.

  49. Alhalaiqa F, Deane KHO, Nawafleh AH, Clark A, Gray R. Adherence therapy for medication non-compliant patients with hypertension: a randomised controlled trial. J Hum Hypertens. 2012;26:117–26.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  50. Amado Guirado E, Pujol Ribera E, Pacheco Huergo V, Borras JM. Knowledge and adherence to antihypertensive therapy in primary care: results of a randomized trial. Gac Sanit. 2011;25:62–7.

    Article  PubMed  Google Scholar 

  51. Austin DL. Selected nursing interventions for noncompliant hypertensive patients [dissertation]. Denton, TX: Texas Women’s University; 1986.

  52. Avanzini F, Corsetti A, Maglione T, Alli C, Colombo F, Torri V, et al. Simple, shared guidelines raise the quality of antihypertensive treatment in routine care. Am Heart J. 2002;144:726–32.

    Article  PubMed  Google Scholar 

  53. Becker LA, Glanz K, Sobel E, Mossey J, Zinn SL, Knott KA. A randomized trial of special packaging of antihypertensive medications. J Fam Pract. 1986;22:357–61.

    CAS  PubMed  Google Scholar 

  54. Beeson SA. The effect of teaching by the nurse on patient knowledge of medications and compliant behavior [master’s thesis]. Greensboro, NC: University of North Carolina; 1977.

  55. Beune EJ, van Charante EP M, Beem L, Mohrs J, Agyemang CO, Ogedegbe G, et al. Culturally adapted hypertension education (CAHE) to improve blood pressure control and treatment adherence in patients of African origin with uncontrolled hypertension: cluster-randomized trial. PLoS One. 2014;9:e90103.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  56. Blenkinsopp A, Phelan M, Bourne J, Dakhil N. Extended adherence support by community pharmacists for patients with hypertension: a randomised controlled trial. Int J Pharm Pract. 2000;8:165–75.

    Article  Google Scholar 

  57. Bogner H, de Vries H. Integration of depression and hypertension treatment: a pilot, randomized controlled trial. Ann Fam Med. 2008;6:295–301.

    Article  PubMed Central  PubMed  Google Scholar 

  58. Boissel JP, Meillard O, Perrin-Fayolle E, Ducruet T, Alamercery Y, Sassano P, et al. Comparison between a bid and a tid regimen: improved compliance with no improved antihypertensive effect. Eur J Clin Pharmacol. 1996;50:63–7.

    Article  CAS  PubMed  Google Scholar 

  59. Bosworth HB, Olsen MK, Neary A, Orr M, Grubber J, Svetkey L, et al. Take Control of Your Blood Pressure (TCYB) study: a multifactorial tailored behavioral and educational intervention for achieving blood pressure control. Patient Educ Couns. 2008;70:338–47.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Burrelle TN. Evaluation of an interdisciplinary compliance service for elderly hypertensives. J Geriatr Drug Ther. 1986;1:23–51.

    Google Scholar 

  61. Carter BL, Doucette WR, Franciscus CL, Ardery G, Kluesner KM, Chrischilles EA. Deterioration of blood pressure control after discontinuation of a physician-pharmacist collaborative intervention. Pharmacotherapy. 2010;30:228–35.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Cooper LA, Roter DL, Carson KA, Bone LR, Larson SM, Miller 3rd ER, et al. A randomized trial to improve patient-centered care and hypertension control in underserved primary care patients. J Gen Intern Med. 2011;26:1297–304.

    Article  PubMed Central  PubMed  Google Scholar 

  63. Erickson SR, Ascione FJ, Kirking DM. Utility of electronic device for medication management in patients with hypertension: a pilot study. J Am Pharm Assoc (2003). 2005;45:88–91.

    Article  Google Scholar 

  64. Evans CE, Haynes RB, Birkett NJ, Gilbert JR, Taylor DW, Sackett DL, et al. Does a mailed continuing education program improve physician performance? Results of a randomized trial in antihypertensive care. JAMA. 1986;255:501–4.

    Article  CAS  PubMed  Google Scholar 

  65. Fernandez S, Scales KL, Pineiro JM, Schoenthaler AM, Ogedegbe G. A senior center-based pilot trial of the effect of lifestyle intervention on blood pressure in minority elderly people with hypertension. J Am Geriatr Soc. 2008;56:1860–6.

    Article  PubMed  Google Scholar 

  66. Fletcher SW, Appel FA, Bourgeois MA. Management of hypertension. Effect of improving patient compliance for follow-up care. J Am Med Assoc. 1975;233:242–4.

    Article  CAS  Google Scholar 

  67. Friedberg JP, Rodriguez MA, Watsula ME, Lin I, Wylie-Rosett J, Allegrante JP, et al. Effectiveness of a tailored behavioral intervention to improve hypertension control: primary outcomes of a randomized controlled trial. Hypertension. 2015;65:440–6.

    Article  CAS  PubMed  Google Scholar 

  68. Gomez-Marcos M, Garcia-Ortiz L, Gonzalez-Elena LJ, Ramos-Delgado E, Gonzalez-Garcia AM, Parra-Sanchez J. Effectiveness of a quality improvement intervention in blood pressure control in primary care. Rev Clin Esp. 2006;206:428–34.

    Article  CAS  PubMed  Google Scholar 

  69. Gonzalez-Fernandez RA, Rivera M, Torres D, Quiles J, Jackson A. Usefulness of a systemic hypertension in-hospital educational program. Am J Cardiol. 1990;65:1384–6.

    Article  CAS  PubMed  Google Scholar 

  70. Hacihasanoğlu R, Gözüm S. The effect of patient education and home monitoring on medication compliance, hypertension management, healthy lifestyle behaviours and BMI in a primary health care setting. J Clin Nurs. 2011;20:692–705.

    Article  PubMed  Google Scholar 

  71. Harowski KJ. The effect of problem solving training on compliance to a medical regimen for hypertension [dissertation]. Missoula, MT: University of Montana; 1983.

  72. Harper DC. Application of Orem’s theoretical constructs to self-care medication behaviors in the elderly. Adv Nurs Sci. 1984;6:29–46.

    Article  CAS  Google Scholar 

  73. Hawkins DW, Fiedler FP, Douglas HL, Eschbach RC. Evaluation of a clinical pharmacist in caring for hypertensive and diabetic patients. Am J Hosp Pharm. 1979;36:1321–5.

    CAS  PubMed  Google Scholar 

  74. Haynes RB, Sackett DL, Gibson ES, Taylor DW, Hackett BC, Roberts RS, et al. Improvement of medication compliance in uncontrolled hypertension. Lancet. 1976;1:1265–8.

    Article  CAS  PubMed  Google Scholar 

  75. Hess PL, Reingold JS, Jones J, Fellman MA, Knowles P, Ravenell JE, et al. Barbershops as hypertension detection, referral, and follow-up centers for black men. Hypertension. 2007;49:1040–6.

    Article  CAS  PubMed  Google Scholar 

  76. Hunt JS, Siemienczuk J, Pape G, Rozenfeld Y, MacKay J, LeBlanc BH, et al. A randomized controlled trial of team-based care: impact of physician-pharmacist collaboration on uncontrolled hypertension. J Gen Intern Med. 2008;23:1966–72.

    Article  PubMed Central  PubMed  Google Scholar 

  77. Inui TS, Yourtee EL, Williamson JW. Improved outcomes in hypertension after physician tutorials. A controlled trial. Ann Intern Med. 1976;84:646–51.

    Article  CAS  PubMed  Google Scholar 

  78. Jafar TH, Hatcher J, Poulter N, Islam M, Hashmi S, Qadri Z, et al. Community-based interventions to promote blood pressure control in a developing country: a cluster randomized trial. Ann Intern Med. 2009;151:593–601.

    Article  PubMed  Google Scholar 

  79. Johnson AL, Taylor DW, Sackett DL, Dunnett CW, Shimizu AG. Self-recording of blood pressure in the management of hypertension. Can Med Assoc J. 1978;119:1034–9.

    PubMed Central  CAS  PubMed  Google Scholar 

  80. Kauric-Klein Z. Improving blood pressure control in end stage renal disease through a supportive educative nursing intervention. Nephrol Nurs J. 2012;39:217–28.

    PubMed  Google Scholar 

  81. Kim KB, Han HR, Huh B, Nguyen T, Lee H, Kim MT. The effect of a community-based self-help multimodal behavioral intervention in korean american seniors with high blood pressure. Am J Hypertens. 2014;27:1199–208.

    Article  PubMed Central  PubMed  Google Scholar 

  82. Kim MT, Kim E, Han H, Jeong S, Lee JE, Park HJ, et al. Mail education is as effective as in-class education in hypertensive Korean patients. J Clin Hypertens. 2008;10:176–84.

    Article  Google Scholar 

  83. Kobalava Z, Villevalde S, Isikova KH, Pavlova E. Impact of integrated approach on blood pressure control in non adherent motivated. 20th European Meeting on Hypertension; Oslo, Norway. pp. e329. Accessed.

  84. Leung LB, Busch AM, Nottage SL, Arellano N, Glieberman E, Busch NJ, et al. Approach to antihypertensive adherence: a feasibility study on the use of student health coaches for uninsured hypertensive adults. Behav Med. 2012;38:19–27.

    Article  PubMed Central  PubMed  Google Scholar 

  85. Levine DM, Green LW, Deeds SG, Chwalow J, Russell RP, Finlay J. Health education for hypertensive patients. J Am Med Assoc. 1979;241:1700.

    Article  CAS  Google Scholar 

  86. Logan AG, Milne BJ, Achber C. A comparison of community and occupationally provided antihypertensive care. J Occup Environ Med. 1982;24:901–6.

    CAS  Google Scholar 

  87. Ma C, Zhou Y, Zhou W, Huang C. Evaluation of the effect of motivational interviewing counselling on hypertension care. Patient Educ Couns. 2014;95:231–7.

    Article  PubMed  Google Scholar 

  88. Magadza C, Radloff SE, Srinivas SC. The effect of an educational intervention on patients’ knowledge about hypertension, beliefs about medicines, and adherence. Res Social Adm Pharm. 2009;5:363–75.

    Article  CAS  PubMed  Google Scholar 

  89. Marquez Contreras E, Casado Martinez JJ, Celotti Gomez B, Gascon Vivo J, Martin de Pablos JL, Gil Rodriguez R, et al. Treatment compliance in arterial hypertension. A 2-year intervention trial through health education. Aten Primaria. 2000;26:5–10.

    Article  CAS  PubMed  Google Scholar 

  90. Marquez Contreras E, de la Figuera von Wichmann M, Gil Guillen V, Ylla-Catala A, Figueras M, Balana M, et al. Effectiveness of an intervention to provide information to patients with hypertension as short text messages and reminders sent to their mobile phone (HTA-Alert). Aten Primaria. 2004;34:399–405.

    Article  CAS  PubMed  Google Scholar 

  91. Marquez Contreras E, Martel Claros N, Gil Guillen V, Martin De Pablos JL, De la Figuera Von Wichman M, Casado Martinez JJ, et al. Non-pharmacological intervention as a strategy to improve antihypertensive treatment compliance. Aten Primaria. 2009;41:501–10.

    Article  PubMed  Google Scholar 

  92. Marquez Contreras E, Vegazo Garca O, Claros NM, Gil Guillen V, de la Figuera von Wichmann M, Casado Martinez J, et al. Efficacy of telephone and mail intervention in patient compliance with antihypertensive drugs in hypertension. ETECUM-HTA study. Blood Press. 2005;14:151–8.

    Article  PubMed  Google Scholar 

  93. Márquez-Contreras E, Martell-Claros N, Gil-Guillén V, Wichmann MF-V, Casado-Martínez JJ, Martin-de Pablos JL, et al. Efficacy of a home blood pressure monitoring programme on therapeutic compliance in hypertension: the EAPACUM-HTA study. J Hypertens. 2006;24:169–75.

    Article  PubMed  Google Scholar 

  94. Martin MY, Kim YI, Kratt P, Litaker MS, Kohler CL, Schoenberger YM, et al. Medication adherence among rural, low-income hypertensive adults: a randomized trial of a multimedia community-based intervention. Am J Health Promot. 2011;25:372–8.

    Article  PubMed Central  PubMed  Google Scholar 

  95. McGillicuddy JW, Gregoski MJ, Weiland AK, Rock RA, Brunner-Jackson BM, Patel SK, et al. Mobile health medication adherence and blood pressure control in renal transplant recipients: a proof-of-concept randomized controlled trial. JMIR Res Protoc. 2013;2, e32. doi:10.2196/resprot.2633.

    Article  PubMed Central  PubMed  Google Scholar 

  96. McKenney JM, Brown ED, Necsary R, Reavis HL. Effect of pharmacist drug monitoring and patient education on hypertensive patients. Contemp Pharm Pract. 1978;1:50–6.

    Google Scholar 

  97. McKenney JM, Slining JM, Henderson HR, Devins D, Barr M. The effect of clinical pharmacy services on patients with essential hypertension. Circulation. 1973;48:1104–11.

    Article  CAS  PubMed  Google Scholar 

  98. McKinstry B, Hanley J, Wild S, Pagliari C, Paterson M, Lewis S, et al. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial. BMJ. 2013;346:f3030. doi:10.1136/bmj.f3030.

    Article  PubMed Central  PubMed  Google Scholar 

  99. Mehos BM, Saseen JJ, MacLaughlin EJ. Effect of pharmacist intervention and initiation of home blood pressure monitoring in patients with uncontrolled hypertension. Pharmacotherapy. 2000;20:1384–9.

    Article  CAS  PubMed  Google Scholar 

  100. Migneault J, Dedier J, Wright J, Heeren T, Campbell M, Morisky D, et al. A culturally adapted telecommunication system to improve physical activity, diet quality, and medication adherence among hypertensive African–Americans: a randomized controlled trial. Ann Behav Med. 2012;1–12.

  101. Mitchell ML. Effects of a self-efficacy intervention on adherence to antihypertensive regimens [dissertation]. Rochester, NY: University of Rochester; 1993.

  102. Moore JM, Shartle D, Faudskar L, Matlin OS, Brennan TA. Impact of a patient-centered pharmacy program and intervention in a high-risk group. J Manag Care Pharm. 2013;19:228–36.

    PubMed  Google Scholar 

  103. Morgado M, Rolo S, Castelo-Branco M. Pharmacist intervention program to enhance hypertension control: a randomised controlled trial. Int J Clin Pharm. 2011;33:132–40.

    Article  PubMed Central  PubMed  Google Scholar 

  104. Muhlhauser I, Sawicki P, Didjurgeit U, Jorgens V, Berger M. Uncontrolled hypertension in type 1 diabetes: assessment of patients’ desires about treatment and improvement of blood pressure control by a structured treatment and teaching programme. Diabet Med. 1988;5:693–8.

    Article  CAS  PubMed  Google Scholar 

  105. Murray MD, Harris LE, Overhage JM, Zhou X, Eckert GJ, Smith FE, et al. Failure of computerized treatment suggestions to improve health outcomes of outpatients with uncomplicated hypertension: results of a randomized controlled trial. Pharmacotherapy. 2004;24:324–37.

    Article  PubMed  Google Scholar 

  106. Ogedegbe G, Chaplin W, Schoenthaler A, Statman D, Berger D, Richardson T, et al. A practice-based trial of motivational interviewing and adherence in hypertensive African Americans. Am J Hypertens. 2008;21:1137–43.

    Article  PubMed Central  PubMed  Google Scholar 

  107. Ogedegbe G, Tobin JN, Fernandez S, Cassells A, Diaz-Gloster M, Khalida C, et al. Counseling African Americans to control hypertension: cluster-randomized clinical trial main effects. Circulation. 2014;129:2044–51.

    Article  PubMed Central  PubMed  Google Scholar 

  108. Oliver S, Jones J, Leonard D, Crabbe A, Delkhah Y, Nesbitt S. Improving adherence with amlodipine/atorvastatin therapy: IMPACT study. J Clin Hypertens. 2011;13:598–604. doi:10.1111/j.1751-7176.2011.00478.x.

    Article  CAS  Google Scholar 

  109. Oparah AC, Adje DUO, Enato EF. Outcomes of pharmaceutical care intervention to hypertensive patients in a Nigerian community pharmacy. Int J Pharm Pract. 2006;14:115–22.

    Article  Google Scholar 

  110. Oser M. Evaluation of a bibliotherapy intervention for improving patients’ adherence to antihypertensive medications [dissertation]. Reno, NV: University of Nevada; 2008.

  111. Park JJ, Kelly P, Carter BL, Burgess PP. Comprehensive pharmaceutical care in the chain setting. J Am Pharm Assoc. 1996;NS36:443–51.

    CAS  Google Scholar 

  112. Park YH, Chang H, Kim J, Kwak JS. Patient‐tailored self‐management intervention for older adults with hypertension in a nursing home. J Clin Nurs. 2013;22:710–22.

    PubMed  Google Scholar 

  113. Patel S, Jacobus-Kantor L, Marshall L, Ritchie C, Kaplinski M, Khurana PS, et al. Mobilizing your medications: an automated medication reminder application for mobile phones and hypertension medication adherence in a high-risk urban population. J Diabetes Sci Technol. 2013;7:630–9.

    Article  PubMed Central  PubMed  Google Scholar 

  114. Pertusa Martínez S, Quirce F, Saavedra MD, Merino J. Evaluation of 3 strategies to improve therapeutic compliance of patients with essential hypertension. Aten Primaria. 1998;22:670–1.

    PubMed  Google Scholar 

  115. Pierce JP, Watson DS, Knights S, Gliddon T, Williams S, Watson R. A controlled trial of health education in the physician’s office. Prev Med. 1984;13:185–94.

    Article  CAS  PubMed  Google Scholar 

  116. Pippalla RS. An impact assessment of pharmacist counseling on pharmaceutical care of hypertensives: interrelationships of compliance, quality of life, and therapeutic outcomes, with some policy perspectives [dissertation]. Morgantown, WV: University of West Virginia; 1994.

  117. Pladevall M, Brotons C, Gabriel R, Arnau A, Suarez C, Marquez E, et al. Multicenter cluster-randomized trial of a multifactorial intervention to improve antihypertensive medication adherence and blood pressure control among patients at high cardiovascular risk (the COM99 study). Circulation. 2010;122:1183–91.

    Article  PubMed Central  PubMed  Google Scholar 

  118. Planas L, Crosby KM, Mitchell KD, Farmer KC. Evaluation of a hypertension medication therapy management program in patients with diabetes. J Am Pharm Assoc (2003). 2009;49:164–70.

    Article  Google Scholar 

  119. Powell KW. Strategy to improve blood pressure control and medication adherence [dissertation]. Chicago, IL: Rush University; 2002.

  120. Resnick B, Shaughnessy M, Galik E, Scheve A, Fitten R, Morrison T, et al. Pilot testing of the PRAISEDD intervention among African-American and low-income older adults. J Cardiovasc Nurs. 2009;24:352–61.

    Article  PubMed  Google Scholar 

  121. Rinfret S, Lussier M, Peirce A, Duhamel F, Cossette S, Lalonde L, et al. The impact of a multidisciplinary information technology-supported program on blood pressure control in primary care. Circulation. 2009;2:170–7.

    PubMed  Google Scholar 

  122. Robinson JD, Segal R, Lopez LM, Doty RE. Impact of a pharmaceutical care intervention on blood pressure control in a chain pharmacy practice. Ann Pharmacother. 2010;44:88–96.

    Article  PubMed  Google Scholar 

  123. Roca-Cusachs A, Sort D, Altimira J, Bonet R, Guilera E, Monmany J, et al. The impact of a patient education programme in the control of hypertension. J Hum Hypertens. 1991;5:437–41.

    CAS  PubMed  Google Scholar 

  124. Rodriguez MA. Is behavior change sustainable for diet, exercise, and medication adherence? [dissertation]. New York, NY: Yeshiva University; 2011.

  125. Roumie CL, Elasy TA, Greevy R, Griffin MR, Liu X, Stone WJ, et al. Improving blood pressure control through provider education, provider alerts, and patient education: a cluster randomized trial. Ann Intern Med. 2006;145:165–75.

    Article  PubMed  Google Scholar 

  126. Ruppar TM. Randomized pilot study of a behavioral feedback intervention to improve medication adherence in older adults with hypertension. J Cardiovasc Nurs. 2010;25:470–9.

    Article  PubMed  Google Scholar 

  127. Saleem F, Hassali MA, Shafie AA, Ul Haq N, Farooqui M, Aljadhay H, et al. Pharmacist intervention in improving hypertensionrelated knowledge, treatment medication adherence and health-related quality of life: a non-clinical randomized controlled trial. Health Expect. 2013. doi:10.1111/hex.12101.

    PubMed  Google Scholar 

  128. Santschi V, Rodondi N, Bugnon O, Burnier M. Impact of electronic monitoring of drug adherence on blood pressure control in primary care: a cluster 12-month randomised controlled study. Eur J Intern Med. 2008;19:427–34.

    Article  PubMed  Google Scholar 

  129. Saunders LD, Irwig LM, Gear JS, Ramushu DL. A randomized controlled trial of compliance improving strategies in Soweto hypertensives. Med Care. 1991;29:669–78.

    Article  CAS  PubMed  Google Scholar 

  130. Schroeder K, Fahey T, Hollinghurst S, Peters TJ. Nurse-led adherence support in hypertension: a randomized controlled trial. Fam Pract. 2005;22:144–51.

    Article  PubMed  Google Scholar 

  131. Sicras-Mainar A, Ibanez J, Firas X, Bulto C, Costa A, Majos N et al. Evaluation of Telemedicine Program (ITHACA): innovation in the treatment of arterial hypertension increasing the compliance and adherence. International Society for Pharmacoeconomics and Outcomes Research 17th Annual Meeting; Washington, D.C. pp. A528. Accessed.

  132. Skaer TL, Sclar DA, Markowski DJ, Won JKH. Effect of value-added utilities in promoting prescription refill compliance among patients with hypertension. Curr Ther Res Clin Exp. 1993;53:251–5.

    Article  Google Scholar 

  133. Solomon DK, Portner TS, Bass GE, Gourley DR, Gourley GA, Holt JM, et al. Clinical and economic outcomes in the hypertension and COPD arms of a multicenter outcomes study. J Am Pharm Assoc. 1998;38:574–85.

    CAS  Google Scholar 

  134. Sookaneknun P, Richards RM, Sanguansermsri J, Teerasut C. Pharmacist involvement in primary care improves hypertensive patient clinical outcomes. Ann Pharmacother. 2004;38:2023–8.

    Article  PubMed  Google Scholar 

  135. Stewart A, Noakes T, Eales C, Shepard K, Becker P, Veriawa Y. Adherence to cardiovascular risk factor modification in patients with hypertension. Cardiovasc J South Afr. 2005;16:102–7.

    CAS  Google Scholar 

  136. Stewart K, George J, Jackson SL, Peterson GM, Hughes JD, McNamara KP et al. Increasing community pharmacy involvement in the prevention of cardiovascular disease. 2008. http://www.5cpa.com.au/iwov-resources/documents/The_Guild/PDFs/CPA%20and%20Programs/4CPA%20General/2007%2008-10/RFT0810%20CVD%20Full%20Final%20Report%20FINAL.pdf. 2012.

  137. Svarstad BL, Kotchen JM, Shireman TI, Brown RL, Crawford SY, Mount JK, et al. Improving refill adherence and hypertension control in black patients: Wisconsin TEAM trial. J Am Pharm Assoc (2003). 2013;53:520–9.

    Article  Google Scholar 

  138. van de Steeg-van Gompel CHPA, Wensing M, De Smet PAGM. Implementation of adherence support for patients with hypertension despite antihypertensive therapy in general practice: a cluster randomized trial. Am J Hypertens. 2010;23:1038–45.

    Article  CAS  Google Scholar 

  139. Vivian EM. Improving blood pressure control in a pharmacist-managed hypertension clinic. Pharmacotherapy. 2002;22:1533–40.

    Article  PubMed  Google Scholar 

  140. Walker CC. An educational intervention for hypertension management in older African Americans. Ethn Dis. 2000;10:165–74.

    CAS  PubMed  Google Scholar 

  141. Wang J, Wu J, Yang J, Zhuang Y, Chen J, Qian W, et al. Effects of pharmaceutical care interventions on blood pressure and medication adherence of patients with primary hypertension in China. Clin Res Regul Aff. 2011;28:1–6.

    Article  Google Scholar 

  142. Wentzlaff DM, Carter BL, Ardery G, Franciscus CL, Doucette WR, Chrischilles EA, et al. Sustained blood pressure control following discontinuation of a pharmacist intervention. J Clin Hypertens. 2011;13:431–7.

    Article  Google Scholar 

  143. Werner RT, Sr. The effects of health education on the compliance of hypertensive patients to medical regimens [dissertation]. Philadelphia, PA: Temple University; 1979.

  144. Wong MC, Liu KQ, Wang HH, Lee CL, Kwan MW, Lee KW, et al. Effectiveness of a pharmacist-led drug counseling on enhancing antihypertensive adherence and blood pressure control: a randomized controlled trial. J Clin Pharmacol. 2013;53:753–61. doi:10.1002/jcph.101.

    Article  PubMed  Google Scholar 

  145. Zang X, Liu J, Chai Y, Wong FKY, Zhao Y. Effect on blood pressure of a continued nursing intervention using chronotherapeutics for adult Chinese hypertensive patients. J Clin Nurs. 2010;19:1149–56.

    Article  PubMed  Google Scholar 

  146. Zillich AJ, Sutherland JM, Kumbera PA, Carter BL. Hypertension outcomes through blood pressure monitoring and evaluation by pharmacists (HOME study). J Gen Intern Med. 2005;20:1091–6.

    Article  PubMed Central  PubMed  Google Scholar 

  147. Mullen PD, Green LW, Persinger GS. Clinical trials of patient education for chronic conditions: a comparative meta-analysis of intervention types. Prev Med. 1985;14:753–81.

    Article  CAS  PubMed  Google Scholar 

  148. Peterson AM, Takiya L, Finley R. Meta-analysis of trials of interventions to improve medication adherence. Am J Health Syst Pharm. 2003;60:657–65.

    PubMed  Google Scholar 

  149. Conn VS, Hafdahl AR, Cooper PS, Ruppar TM, Mehr DR, Russell CL. Interventions to improve medication adherence among older adults: meta-analysis of adherence outcomes among randomized controlled trials. Gerontologist. 2009;49:447–62.

    Article  PubMed  Google Scholar 

  150. Chase J, Bogener J, Ruppar T, Conn V. The effectiveness of medication adherence interventions among patients with coronary artery disease: a meta-analysis. J Cardiovasc Nurs. 2015. doi:10.1097/JCN.0000000000000259.

    Google Scholar 

  151. Ruppar T. Improvement in heart failure mortality and readmission outcomes from medication adherence interventions: a meta-analysis. 2015.

  152. Conn V, Ruppar T, Enriquez M, Cooper P. Medication adherence interventions that target subjects with adherence problems: systematic review and meta-analysis. Res Social Adm Pharm. In press.

  153. Conn V, Enriquez M, Ruppar T, Chan K. Cultural relevance in medication adherence interventions with underrepresented adults: systematic review and meta-analysis of outcomes. Prev Med. 2014;69:239–47.

    Article  PubMed  Google Scholar 

  154. Perreault S, Dragomir A, White M, Lalonde L, Blais L, Berard A. Better adherence to antihypertensive agents and risk reduction of chronic heart failure. J Intern Med. 2009;266:207–18.

    Article  CAS  PubMed  Google Scholar 

  155. Lowy A, Munk VC, Ong SH, Burnier M, Vrijens B, Tousset EP, et al. Effects on blood pressure and cardiovascular risk of variations in patients’ adherence to prescribed antihypertensive drugs: role of duration of drug action. Int J Clin Pract. 2011;65:41–53.

    Article  CAS  PubMed  Google Scholar 

  156. Mancia G, Messerli F, Bakris G, Zhou Q, Champion A, Pepine CJ. Blood pressure control and improved cardiovascular outcomes in the International Verapamil SR-Trandolapril Study. Hypertension. 2007;50:299–305.

    Article  CAS  PubMed  Google Scholar 

  157. Mazzaglia G, Ambrosioni E, Alacqua M, Filippi A, Sessa E, Immordino V, et al. Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation. 2009;120:1598–605.

    Article  CAS  PubMed  Google Scholar 

  158. Roebuck MC, Liberman JN, Gemmill-Toyama M, Brennan TA. Medication adherence leads to lower health care use and costs despite increased drug spending. Health Aff (Millwood). 2011;30:91–9.

    Article  Google Scholar 

  159. Iuga AO, McGuire MJ. Adherence and health care costs. Risk Manag Healthc Policy. 2014;7:35–44.

    PubMed Central  PubMed  Google Scholar 

  160. Shimizu M, Shibasaki S, Kario K. The value of home blood pressure monitoring. Curr Hypertens Rep. 2006;8:363–7.

    Article  PubMed  Google Scholar 

  161. Alsabbagh MH, Lemstra M, Eurich D, Lix LM, Wilson TW, Watson E, et al. Socioeconomic status and nonadherence to antihypertensive drugs: a systematic review and meta-analysis. Value Health. 2014;17:288–96.

    Article  PubMed  Google Scholar 

  162. Conn VS, Groves PS. Protecting the power of interventions through proper reporting. Nurs Outlook. 2011;59:318–25.

    Article  PubMed Central  PubMed  Google Scholar 

  163. Michie S, Prestwich A. Are interventions theory-based? Development of a theory coding scheme. Health Psychol. 2010;29:1–8.

    Article  PubMed  Google Scholar 

  164. Burnier M, Wuerzner G, Struijker-Boudier H, Urquhart J. Measuring, analyzing, and managing drug adherence in resistant hypertension. Hypertension. 2013;62:218–25.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The project was supported by Award Numbers 13GRNT16550001 (Conn-principal investigator) from the American Heart Association and R01NR011990 (Conn-principal investigator) from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Heart Association or the National Institutes of Health.

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Authors and Affiliations

  1. School of Nursing, University of Missouri, S317 Sinclair Building, Columbia, MO, 65211, USA

    Vicki S. Conn

  2. School of Nursing, University of Missouri, S423 Sinclair Building, Columbia, MO, 65211, USA

    Todd M. Ruppar

  3. School of Nursing, University of Missouri, S343 Sinclair Building, Columbia, MO, 65211, USA

    Jo-Ana D. Chase

  4. School of Nursing, University of Missouri, S327 Sinclair Building, Columbia, MO, 65211, USA

    Maithe Enriquez

  5. School of Nursing, University of Missouri, S318 Sinclair Building, Columbia, MO, 65211, USA

    Pamela S. Cooper

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  1. Vicki S. Conn
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Correspondence to Vicki S. Conn.

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Drs. Conn and Cooper report grants from American Heart Association and the National Institutes of Health. Drs. Chase, Enriquez, and Ruppar have no conflicts of interest.

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This article is part of the Topical Collection on Prevention of Hypertension: Public Health Challenges

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Conn, V.S., Ruppar, T.M., Chase, JA.D. et al. Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis. Curr Hypertens Rep 17, 94 (2015). https://doi.org/10.1007/s11906-015-0606-5

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