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Complex intervention could improve adherence to antihypertensive medication, BP control

Stephen Padilla
03 Oct 2016
New findings through gene mapping may lead to a cure for hypertension

The complex approach strategy, which includes educational programmes, reminding tips, and state-of-the-art therapy, may significantly increase patient adherence to antihypertensive treatment and improve blood pressure (BP) control in everyday routine practice, according to the PRISMA* study presented at the International Society of Hypertension (ISH) 2016 meeting in Seoul, Korea.

One major contributor to poor BP control is non-adherence to antihypertensive medication, which may be caused by patient-related factors such as lack of motivation or risk understanding. Researchers then conducted a randomized trial to determine the impact of an integrated approach with therapy based on perindopril arginine in the improvement of motivation, adherence to antihypertensive treatment, and BP control.

A total of 906 non-adherent (score <4 in Morisky and Green Test for Measure of Adherence to Therapy) hypertensive patients (mean age 56 years; 315 male) with planning or action stages of behaviour changes and uncontrolled hypertension (BP >140/90 mmHg) were randomized to receive either an integrated approach with therapy based on perindopril arginine with added-on therapy if necessary (intervention group; n=755) or routine practice (routine practice group; n=151).

The strategy included educational programmes for both patients and physicians, individualised risk assessment, adoption of lifestyle changes, frequent follow-up visits with questionnaires and discussion, phone reminding, and regular home BP measurement. During the 12-month study period, patients received food and physical activity pyramid cards, and diary for recording home BP.

The primary outcomes were mean systolic and diastolic BPs, and the proportion of patients with controlled BP at month 6. Secondary outcomes included proportion of adherent patients and prevalence of stages of behaviour at month 6.

The intervention group had more significant improvement in BP control than the routine practice group (achieved BP <140/90 mmHG in 87.2 vs 68.5 percent of patients, respectively; χ2=3; p<0.05). The absolute BP decrease was also better in the intervention group (159/95 vs 127/79 mmHG) than in the routine practice group (161/95 vs 133/81 mmHg; p<0.05 for each). [ISH 2016, abstract LBOS 01-06]

Compared with routine practice, the intervention group had more patients who became adherent to antihypertensive treatment (71.7 vs 52.2 percent; χ2=25.8; p<0.001), more patients with planning or action stages of behaviour changes who increased motivation to maintenance stage (71.1 vs 43.5 percent; χ2=47.5; p<0.001), and lesser relapses of behaviour changes into pre-contemplation or contemplation stages (3.8 vs 8.6 percent; χ2=10.2; p<0.001).

Lead researcher Svetlana Villevalde, from the Department of Cardiology, Clinical Pharmacology, People’s Friendship University of Russia, said that “79 percent of uncontrolled hypertension may be related to non-adherence to antihypertensive treatment” and “70 percent of non-adherent patients are motivated to change medication-taking behaviour.”

<insert Dr Svetlana Villevalde>

The study has several strengths, such as the large number of patients and physicians, as well as the implementation of integrated approach addressed at main domains of non-adherence. However, it is limited by non-cluster randomization.

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