An intervention to improve compliance and hypertension control

January 01, 0001

An intervention to improve compliance and hypertension control

Hypertension can be difficult to control, often requiring several medications with can lead to compliance issues. These Spanish and US researchers examined the effectiveness of a multifactorial intervention to improve both medication adherence and blood pressure control. They performed a multicenter, cluster-randomized trial in which Spanish physicians (n=79) were randomized to receive and provide the intervention to their high-risk patients. Eligible patients (n=877) were 50 years of age or older with uncontrolled hypertension and an estimated 10-year cardiovascular risk greater than 30%. The mean duration of follow-up was 39 months. Physicians in the intervention group counted patients' pills, designated a family member to support adherence behavior, and provided educational information to patients. The primary outcome was blood pressure and secondary outcomes included medication adherence and a composite end point of all-cause mortality and cardiovascular-related hospitalizations.

The researchers found: "Intervention patients were less likely to have an uncontrolled systolic blood pressure (odds ratio 0.62) and were more likely to be adherent (odds ratio 1.91) than control group patients at 6 months. After 5 years, 16% of the patients in the intervention group and 19% in the control group met the composite end point (hazard ratio 0.97)."

The researchers concluded: "A multifactorial intervention to improve adherence to antihypertensive medication was effective in improving both adherence and blood pressure control, but it did not appear to improve long-term cardiovascular events."

This study suggests a possible intervention to improve compliance and hypertension control, but the mortality outcome was dissappointing

For the full abstract, click here.

Circulation 122(12):1183-1191, 21 September 2010
© 2010 American Heart Association, Inc.
Multicenter Cluster-Randomized Trial of a Multifactorial Intervention to Improve Antihypertensive Medication Adherence and Blood Pressure Control Among Patients at High Cardiovascular Risk (The COM99 Study). Manel Pladevall, Carlos Brotons, Rafael Gabriel, et al. Correspondence to Manel Pladevall:

Category: K. Circulatory. Keywords: hypertension, medications, compliance, intervention, cardiovascular, randomized trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 29 October 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.