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Abstract
BackgroundHypertension control through pharmacological treatment has led to substantial benefits in the prevention of morbidity and mortality from cardiovascular diseases. However, evidence from a number of studies suggests that as many as 50 to 80 % of patients treated for hypertension have low adherence to their treatment regimen. The objective of this systematic review is to evaluate the effectiveness of medication adherence interventions for hypertension. In addition, we aim to explore what barriers and facilitators in the interventions may have been targeted and how these might be related to the effect size on blood pressure (BP).MethodsThis review is a hypertension-specific update to the previous Cochrane Review by Nieuwlaat et al. (2014) on interventions to enhance medication adherence. A systematic literature search will be carried out, and two authors will independently screen titles and abstracts for their eligibility for inclusion and independently extract data from the selected studies and assess the methodological quality using the Cochrane Collaboration Risk of Bias Tool. A meta-analysis will be conducted, and additionally, theoretical factors in interventions will be identified using the Theoretical Domains Framework.DiscussionThis review will generate new information by quantitatively evaluating the effectiveness of adherence interventions for hypertension and potentially identify which theoretical domains are associated with more effective interventions and which domains have not been the subject of intervention development.Systematic review registrationPROSPERO CRD42016033358Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0278-5) contains supplementary material, which is available to authorized users.
Highlights
Hypertension control through pharmacological treatment has led to substantial benefits in the prevention of morbidity and mortality from cardiovascular diseases
The objective of this review is to evaluate the effectiveness of adherence interventions for hypertension and explore which specific barriers and facilitators the interventions may have been targeting and how this tailored approach might be related to the effect size on blood pressure and medication adherence
Due to population growth, ageing and behavioural risk factors, such as unhealthy diet, harmful use of alcohol, lack of physical activity, excess weight and exposure to persistent stress, there has been a significant growth in the incidence of hypertension; the number of people with hypertension rose from 600 million in 1980 to 1 billion in 2008 [22]
Summary
Hypertension control through pharmacological treatment has led to substantial benefits in the prevention of morbidity and mortality from cardiovascular diseases. Evidence from a number of studies suggests that as many as 50 to 80 % of patients prescribed pharmacological antihypertensive therapy have low adherence to their treatment regimen [9]. Vrijens et al [10] used medication event monitor system (MEMS) data to measure adherence to antihypertensive medications and found that about half of all patients prescribed the medications stopped taking them within one year of the initial prescription. They found that on any one day, 10 % of patients omitted their scheduled dose of medication. According to the WHO, this lack of adherence to antihypertensive medication is the most important cause of failure to achieve BP control [7]
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