Effects of Daily Adherence to Antihypertensive Medication on Blood Pressure Control

Rose, Adam J.; Glickman, Mark E.; D'Amore, Meredith; Orner, Michelle B.; Berlowitz, Dan R.; Kressin, Nancy R.

doi:10.1111/j.1751-7176.2011.00427.x

Cited by 26 publications

(29 citation statements)

References 25 publications

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“…In contemporary treated hypertensive patients, those classified as nonadherent are most commonly partially adherent. 27,28 In our recent study, examining patterns of nonadherence to multiple antihypertensives, we found that most dose omissions were of short duration and could potentially be compensated for with long-acting antihypertensives. 29 Encouraging full adherence remains an important public health priority.…”

Section: Discussionmentioning

confidence: 98%

Characteristics, drug combinations and dosages of primary care patients with uncontrolled ambulatory blood pressure and high medication adherence

Grigoryan

Pavlik

Hyman

2013

Journal of the American Society of Hypertension

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Most studies on the prevalence and determinants of resistant hypertension (RH) do not account for white coat hypertension, medication non-adherence, or use of suboptimal treatment dosages. We studied the characteristics, drug combinations, and dosages of patients on at least three antihypertensives of different classes who had uncontrolled blood pressure on 24-hour ambulatory blood pressure monitoring and high medication adherence measured by electronic monitoring. The data were collected as part of the baseline measures of a hypertension control trial. Of 140 monitored primary care patients, all with uncontrolled office blood pressure, 69 (49%) were on at least three antihypertensives of different classes. Of these 69, 15 (22%) were controlled on ambulatory blood pressure monitoring, 20 (29%) were uncontrolled and non-adherent, leaving only 34 (49%) adherent to their medications and having uncontrolled ambulatory hypertension (uncontrolled RH). Thirty-one (91%) of the 34 uncontrolled RH patients were prescribed a diuretic, of which 24 were on hydrochlorothiazide 25 mg. Less than half of the patients on angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or calcium channel blocker were prescribed maximal doses of these agents. Half of the RH can be attributed to white coat effect and poor medication adherence, and all of the remaining patients were on apparently suboptimal drug combinations and/or dosages. Primary care physicians need to be educated regarding the optimal treatment of RH.

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Section: Discussionmentioning

confidence: 98%

Characteristics, drug combinations and dosages of primary care patients with uncontrolled ambulatory blood pressure and high medication adherence

Grigoryan

Pavlik

Hyman

2013

Journal of the American Society of Hypertension

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“…20,21 Intervention patients were given an electronic home BP monitor and written step-by-step instructions for checking their BP at home. Research associates also demonstrated use of the monitor during enrollment to ensure that low-literacy patients understood the procedure.…”

Section: Interventionmentioning

confidence: 99%

Hypertension Management Using Mobile Technology and Home Blood Pressure Monitoring: Results of a Randomized Trial in Two Low/Middle-Income Countries

Piette

Datwani

Gaudioso

et al. 2012

Telemedicine and e-Health

152

195

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Objective: Hypertension and other noncommunicable diseases represent a growing threat to low/middle-income countries (LMICs). Mobile health technologies may improve noncommunicable disease outcomes, but LMICs lack resources to provide these services. We evaluated the efficacy of a cloud computing model using automated self-management calls plus home blood pressure (BP) monitoring as a strategy for improving systolic BPs (SBPs) and other outcomes of hypertensive patients in two LMICs. Subjects and Methods: This was a randomized trial with a 6-week follow-up. Participants with high SBPs ( ‡140 mm Hg if nondiabetic and ‡130 mm Hg if diabetic) were enrolled from clinics in Honduras and Mexico. Intervention patients received weekly automated monitoring and behavior change telephone calls sent from a server in the United States, plus a home BP monitor. At baseline, control patients received BP results, hypertension information, and usual healthcare. The primary outcome, SBP, was examined for all patients in addition to a preplanned subgroup with low literacy or high hypertension information needs. Secondary outcomes included perceived health status and medicationrelated problems. Results: Of the 200 patients recruited, 181 (90%) completed follow-up, and 117 of 181 had low literacy or high hypertension information needs. The median annual income was $2,900 USD, and average educational attainment was 6.5 years. At follow-up intervention patients' SBPs decreased 4.2 mm Hg relative to controls (95% confidence interval -9.1, 0.7; p = 0.09). In the subgroup with high information needs, intervention patients' average SBPs decreased 8.8 mm Hg ( -14.2, -3.4, p = 0.002). Compared with controls, intervention patients at follow-up reported fewer depressive symptoms (p = 0.004), fewer medication problems (p < 0.0001), better general health (p < 0.0001), and greater satisfaction with care (p £ 0.004). Conclusions: Automated telephone care management plus home BP monitors can improve outcomes for hypertensive patients in LMICs. A cloud computing model within regional telecommunication centers could make these services available in areas with limited infrastructure for patient-focused informatics support.

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“…On the other hand, our finding was in line with Rose et al . and Matsumura et al . whereby improving patient adherence to their antihypertensive medicines was associated with better blood pressure.…”

Section: Discussionmentioning

confidence: 95%

Improving medication adherence through calendar packaging: results of a randomized controlled trial among hypertensive patients

Tan

Shafie

Saleem

et al. 2017

J Pharm Health Serv Res

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Objective This study aimed to investigate the effect of calendar packaging (CP) on medication adherence among hypertensive patients in Malaysia. Setting Outpatient Pharmacy Department, Kulim Hospital. Methods This was a parallel randomized controlled trial of CP (intervention group) versus normal pack (control group) for patients who were on daily dose antihypertensive drug (amlodipine).The primary outcome was medication adherence to amlodipine, assessed by medication possession ratio (MPR), percentage of on‐time refills and Malay Version Morisky medication adherence scales. Key findings Eighty‐three patients participated. The mean age (standard deviation) was 55.85 (10.25) and 56.55 (10.42) for intervention and control group respectively. This study found that intervention group has better medication adherence score than the control group measured by MPR, Morisky medication adherence score (P < 0.05) and percentage of on‐time refills (P < 0.01). Intervention group showed a significantly lower systolic and diastolic blood pressure (P < 0.05) compared to control group. Intervention group was significantly associated with higher medication adherence measured by MPR (β = 0.006, P < 0.05), Morisky scale (β = 0.365, P < 0.05) and percentage of on‐time refill (β = 0.063, P < 0.01); in addition lower systolic blood pressure (β = −4.4, P < 0.05) after controlling for the study period and patient age. Conclusions This study found that CP could improve adherence to medication among hypertensive patients. The results also suggest possible improvement in blood pressure with the use of CP.

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Effects of Daily Adherence to Antihypertensive Medication on Blood Pressure Control

Cited by 26 publications

References 25 publications

Characteristics, drug combinations and dosages of primary care patients with uncontrolled ambulatory blood pressure and high medication adherence

Characteristics, drug combinations and dosages of primary care patients with uncontrolled ambulatory blood pressure and high medication adherence

Hypertension Management Using Mobile Technology and Home Blood Pressure Monitoring: Results of a Randomized Trial in Two Low/Middle-Income Countries

Improving medication adherence through calendar packaging: results of a randomized controlled trial among hypertensive patients

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