Cochrane Summaries

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What interventions improve adherence to treatment in patients with high blood pressure in ambulatory settings

Schroeder K, Fahey T, Ebrahim S
Published Online: 
8 October 2008

High blood pressure is a major risk factor for heart attack and stroke, and drug treatment of high blood pressure can substantially reduce this risk. However, the control of high blood pressure in the community is far from optimal. One of the major reasons for this is that patients with high blood pressure often fail to take their medication as prescribed. A number of interventions have been tested that aim to help patients take their medication but it is still uncertain how effective they are.

This review evaluates the effectiveness of interventions aiming to help patients with taking blood pressure lowering medication. We included studies in adult patients with a diagnosis of high blood pressure in a community setting and assessed interventions that aimed to increase adherence to blood pressure lowering medication. The outcomes assessed were adherence to medication and blood pressure changes.

For many interventions it is difficult to draw any real conclusions due to weaknesses of the included studies. However, reducing the number of daily doses appears to be effective in increasing adherence to blood pressure lowering medication and should be tried as a first line strategy although there is little evidence of an effect on blood pressure reduction. Some motivational strategies and complex interventions appear promising but we need more evidence on their effect through carefully designed randomised controlled trials to confirm these findings.