Systematic review of motivational interventions to improve adherence to medication in patients with hypertension and meta-analysis

B Rosendo-Silva; A C Ortigosa-Ferreira; F Prazeres; F Caramelo; L M Santiago; I Rosendo

doi:10.1016/j.hipert.2023.04.003

Systematic review of motivational interventions to improve adherence to medication in patients with hypertension and meta-analysis

Hipertens Riesgo Vasc. 2023 Oct 26:S1889-1837(23)00025-9. doi: 10.1016/j.hipert.2023.04.003. Online ahead of print.

Authors

B Rosendo-Silva¹, A C Ortigosa-Ferreira², F Prazeres³, F Caramelo⁴, L M Santiago⁵, I Rosendo⁶

Affiliations

¹ UCSP Figueira Sul, Coimbra, Portugal; Faculty of Medicine of the University of Coimbra, Portugal; Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal. Electronic address: beatrizrosendosilva@gmail.com.
² Faculty of Medicine of the University of Coimbra, Portugal.
³ Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal; Departamento de Ciências Médicas, Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal; USF Beira Ria, Gafanha da Nazaré, Portugal.
⁴ University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.
⁵ General Practice/Family Medicine Clinic of the Faculty of Medicine of the University of Coimbra, Portugal; Centre for Health Studies and Research of the University of Coimbra (CEISUC), Coimbra, Portugal.
⁶ General Practice/Family Medicine Clinic of the Faculty of Medicine of the University of Coimbra, Portugal; USF Coimbra Centro, Coimbra, Portugal.

PMID: 39492317
DOI: 10.1016/j.hipert.2023.04.003

Abstract

Introduction: Antihypertensive medication non-adherence is an important cause of poor control in hypertension. The role of motivational interventions to increase antihypertensive medication adherence remains unclear.

Objective: To systematically review RCTs of motivational interventions for improving medication adherence in hypertension.

Methods: EMBASE and Pubmed were searched from inception to February 2019 for RCTs of motivational interventions for improving medication adherence in hypertension vs. usual care.

Inclusion criteria: RCTs with motivational intervention to improve medication adherence in adults with hypertension. A blinded review was conducted by 2 reviewers. Disagreements were resolved by consensus/a third reviewer. Data extraction and quality appraisal was performed using the risk of bias tool from cochrane collaboration. The meta-analyses of blood pressure control used random-effects models to report mean difference and 95% CIs. Primary outcome was medication adherence and second outcome was blood pressure control.

Results: The search methodology yielded 10 studies comprising 1171 participants. Medication adherence improved significantly in 5 studies. We could not perform pool analysis for this outcome due to different measurements of medication adherence. Seven trials reported significant results regarding blood pressure control. On pooled analysis, motivational interventions were not significantly associated with a systolic blood pressure (mean difference, -0.06; 95% CI, -0.05 to 0.18; p=0.63; I²=0.0%) or diastolic blood pressure (mean difference, -0.11; 95% CI, -0.10 to 0.31; p=0.28; I²=23.8%) decrease or blood pressure control.

Conclusions: Motivational interventions seem to significantly improve medication adherence but not significantly blood pressure control in hypertension, although evidence is still being based on few studies, with unclear risk of bias.

Keywords: Adherencia farmacológica; Blood pressure control; Control de la presión arterial; Hipertensión; Hypertension; Intervenciones motivacionales; Motivational interventions; Pharmacological adherence.