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

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.

Blood pressure outcomes of medication adherence interventions: systematic review and meta-analysis

“…A recent meta-analysis of medication adherence behavior outcomes of interventions to increase adherence reported an overall standardized mean difference effect size of only 0.300. This was consistent with treatment subjects taking 4% more of their prescribed daily doses than control subjects at outcome (Conn et al, in press). These findings suggest blood pressure interventions are not lowering blood pressure because they are not increasing medication adherence.…”

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