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Strategies to Improve Adherence to Anti-Hypertensive Medications: a Narrative Review

  • Implementation to Increase Blood Pressure Control: What Works? (J Brettler and K Reynolds, Section Editors)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Medication adherence is critical for effective management of hypertension, yet half of patients with hypertension are non-adherent to medications. In this review, we describe and critically evaluate medication adherence interventions published in the past 3 years for patients with hypertension.

Recent Findings

We identified 1593 articles and 163 underwent full review, of which 42 studies met the inclusion criteria. Studies were classified into eight categories: simplification of medication regimen (e.g., fixed dose combination pills); electronic Health (eHealth) tools (e.g., text messaging reminders); behavioral counseling (e.g., motivational interviewing); healthcare system changes (e.g., patient-centered medical home); patient education; multicomponent chronic disease management program; home blood pressure monitoring; and financial incentives. Studies utilizing strategies to simplify medication regimens, eHealth tools, patient education, and behavioral counseling were most likely to report positive findings.

Summary

Interventions targeting patient behavior were more likely to be associated with improvements in medication adherence compared to those targeting providers or the healthcare system. eHealth tools show promise for augmenting behavioral interventions. A major limitation of included trials was short study duration and use of self-report measures of medication adherence. Future research should explore how complex interventions that utilize a combination of evidence-based strategies and target multiple adherence behaviors (e.g., both day-to-day medication taking and long-term persistence) may be efficacious in improving medication adherence.

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

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Acknowledgments

We would like to acknowledge Mr. Timothy Roberts for his assistance in developing the search strategy for this review.

Funding

Preparation of this article was supported in part by the National Institutes of Health grant T32HL129953 - Mentoring URM Scientists in Behavioral and Cardiovascular Health to Increase Academic Workforce Diversity and American Heart Association grant 19POST34380633. The sponsors had no role in the study design, in the collection, analysis, or interpretation of the findings, in writing the present report, or in the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Population Health, Center for Healthful Behavior Change, New York University Grossman School of Medicine, New York, NY, USA

    Chigozirim Izeogu & Antoinette Schoenthaler

  2. Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA

    Jolaade Kalinowski

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Correspondence to Antoinette Schoenthaler.

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Appendix A. Review Search Strategy

Appendix A. Review Search Strategy

((("hypertension"[MeSH Terms] OR hypertension[Text Word]) OR blood pressure[Text Word]) OR ("blood pressure"[MeSH Terms] OR "blood pressure determination"[MeSH Terms] OR "arterial pressure"[MeSH Terms])) AND ("Medication Adherence"[Mesh] OR "medication adherence"[tw] OR "medication nonadherence"[tw]) AND (((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical trials as topic[MeSH Terms] OR clinical trial[Publication Type] OR random*[Title/Abstract] OR random allocation[MeSH Terms] OR therapeutic use[MeSH Subheading]))

“Medication Adherence” [Mesh] OR adherence[tw] OR nonadherence[tw] OR … adherence, adherent, compliance, compliant, noncompliant, noncompliance, nonadherence, nonadherent

AND ((((((((((hypertension[MeSH Terms]) OR hypertension[Text Word]) OR blood pressure[Text Word]) OR blood pressure[MeSH Terms])

AND (((((Prospective Studies[MeSH Terms]) OR Cohort Studies[MeSH Terms]) OR Followup Studies[MeSH Terms]) OR Longitudinal Studies[MeSH Terms]) AND Cross Sectional Studies[MeSH Terms])

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Izeogu, C., Kalinowski, J. & Schoenthaler, A. Strategies to Improve Adherence to Anti-Hypertensive Medications: a Narrative Review. Curr Hypertens Rep 22, 105 (2020). https://doi.org/10.1007/s11906-020-01115-4

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