Analysis 01.01. Comparison 01 Active intervention versus control, Outcome 01 Self monitoring (systolic blood pressure) Analysis 01.02. Comparison 01 Active intervention versus control, Outcome 02 Self monitoring (diastolic blood pressure

Reducing the number of daily doses appears to be effective in increasing adherence to blood pressure-lowering medication and should be tried as a first-line strategy, although there is so far less evidence of an effect on blood pressure reduction. Some motivational strategies and complex interventions appear promising, but we need more evidence on their effect through carefully designed randomized controlled trials.

Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings. Cochrane Database Syst Rev (2). CD004804.

Over-the-counter (OTC) medications for acute cough in children and adults in community settings (Review)

The evidence in our review demonstrates that intensification of patient care interventions improves short- and long-term medication adherence, as well as total cholesterol and LDL-cholesterol levels. Healthcare systems which can implement team-based intensification of patient care interventions may be successful in improving patient adherence rates to lipid-lowering medicines.

Patients with high blood pressure (hypertension) in the community frequently fail to meet treatment goals: a condition labelled as 'uncontrolled' hypertension. The optimal way to organise and deliver care to hypertensive patients has not been clearly identified. AimTo determine the effectiveness of interventions to improve control of blood pressure in patients with hypertension. Design of studySystematic review of randomised controlled trials. SettingPrimary and ambulatory care. MethodInterventions were categorised as following: selfmonitoring; educational interventions directed to the patient; educational interventions directed to the health professional; health professional-(nurse or pharmacist) led care; organisational interventions that aimed to improve the delivery of care; and appointment reminder systems. Outcomes assessed were mean systolic and diastolic blood pressure, control of blood pressure and proportion of patients followed up at clinic. ResultsSeventy-two RCTs met the inclusion criteria. The trials showed a wide variety of methodological quality. Selfmonitoring was associated with net reductions in systolic blood pressure (weighted mean difference [WMD] -2.5mmHg, 95%CI = -3.7 to -1.3 mmHg) and diastolic blood pressure (WMD -1.8mmHg, 95%CI = -2.4 to -1.2 mmHg). An organised system of regular review allied to vigorous antihypertensive drug therapy was shown to reduce blood pressure and all-cause mortality in a single large randomised controlled trial. ConclusionAntihypertensive drug therapy should be implemented by means of a vigorous stepped care approach when patients do not reach target blood pressure levels. Selfmonitoring is a useful adjunct to care while reminder systems and nurse/pharmacist -led care require further evaluation. Keywordshypertension; prevention and control; primary care; systematic review. INTRODUCTIONHypertension is largely managed in primary care and is an important public health problem in terms of associated stroke and cardiovascular events. It is mostly of unknown aetiology, easy to diagnose, and readily preventable by blood pressure reduction. Extensive epidemiological data have strengthened the well-recognised relationship between blood pressure and risk of cardiovascular disease, and have confirmed the importance of systolic blood pressure as a determinant of risk.1 However, blood pressure goals are achieved in only 25-40% of the patients who take antihypertensive drug treatment, 2,3 which is something that has remained unchanged for the last 40 years. 4 Use of self-monitoring of blood pressure by patients and professionals has gained popularity andLG Glynn, MD, FRCSI, MRCGP, MICGP, senior is now recommended in particular patients in certain national and international guidelines; a recent metaanalysis of randomised trials on the subject did suggested a benefit in terms of mean blood pressure and blood pressure control. 5 This systematic review aims to update and build upon previous reviews, 6,7 by summarising the evidence from randomised controlled trials (RCTs) ...

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