Trials to improve blood pressure through adherence to antihypertensives in stroke/TIA:systematic review and meta-analysis.

De Simoni, Anna, Hardeman, Wendy, Mant, Jonathan, Farmer, Andrew J. and Kinmonth, Ann Louise (2013) Trials to improve blood pressure through adherence to antihypertensives in stroke/TIA:systematic review and meta-analysis. Journal of the American Heart Association, 2 (4). ISSN 2047-9980

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Abstract

The purpose of this study was to determine whether interventions including components to improve adherence to antihypertensive medications in patients after stroke/transient ischemic attack (TIA) improve adherence and blood pressure control. We searched MEDLINE, EMBASE, CINAHL, BNI, PsycINFO, and article reference lists to October 2012. Search terms included stroke/TIA, adherence/prevention, hypertension, and randomized controlled trial (RCT). Inclusion criteria were participants with stroke/TIA; interventions including a component to improve adherence to antihypertensive medications; and outcomes including blood pressure, antihypertensive adherence, or both. Two reviewers independently assessed studies to determine eligibility, validity, and quality. Seven RCTs were eligible (n=1591). Methodological quality varied. All trials tested multifactorial interventions. None targeted medication adherence alone. Six trials measured blood pressure and 3 adherence. Meta-analysis of 6 trials showed that multifactorial programs were associated with improved blood pressure control. The difference between intervention versus control in mean improvement in systolic blood pressure was -5.3 mm Hg (95% CI, -10.2 to -0.4 mm Hg, P=0.035; I(2)=67% [21% to 86%]) and in diastolic blood pressure was -2.5 mm Hg (-5.0 to -0.1 mm Hg, P=0.046; I(2)=47% [0% to 79%]). There was no effect on medication adherence where measured. Multifactorial interventions including a component to improve medication adherence can lower blood pressure after stroke/TIA. However, it is not possible to say whether or not this is achieved through better medication adherence. Trials are needed of well-characterized interventions to improve medication adherence and clinical outcomes with measurement along the hypothesized causal pathway.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Related URLs:
Depositing User: Pure Connector
Date Deposited: 19 Nov 2015 08:18
Last Modified: 17 Mar 2020 21:09
URI: https://ueaeprints.uea.ac.uk/id/eprint/55420
DOI: 10.1161/JAHA.113.000251

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