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

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2023-10-01 DOI:10.1016/j.hipert.2023.04.003

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

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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.

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动机干预提高高血压患者服药依从性的系统综述及meta分析

前言降压药依从性不良是高血压控制不良的重要原因。动机干预在增加抗高血压药物依从性中的作用尚不清楚。目的系统回顾动机干预提高高血压患者药物依从性的随机对照试验。方法检索sembase和Pubmed从成立到2019年2月的随机对照试验，以改善高血压患者的药物依从性与常规治疗的动机干预。纳入标准:采用动机干预提高成人高血压患者药物依从性的随机对照试验。由2位审稿人进行盲法评价。分歧由一致意见/第三审稿人解决。使用cochrane协作的偏倚风险工具进行数据提取和质量评估。血压控制的荟萃分析使用随机效应模型报告平均差异和95% ci。主要结局是药物依从性，第二结局是血压控制。搜索方法产生了10项研究，包括1171名参与者。在5项研究中，药物依从性显著改善。由于药物依从性的测量方法不同，我们无法对该结果进行池分析。七项试验报告了在血压控制方面的显著结果。在汇总分析中，动机干预与收缩压无显著相关(平均差异为- 0.06;95% CI，−0.05 ~ 0.18;p = 0.63;I2 = 0.0%)或舒张压(平均差值- 0.11;95% CI，−0.10 ~ 0.31;p = 0.28;I2 = 23.8%)降低或控制血压。结论:动机性干预措施似乎可以显著改善高血压患者的药物依从性，但不能显著改善血压控制，尽管证据仍然基于少数研究，偏倚风险尚不清楚。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.