Open AccessTrials to Improve Blood Pressure Through Adherence to Antihypertensives in Stroke/ TIA : Systematic Review and Meta‐Analysis
Author(s) -
Simoni Anna,
Hardeman Wendy,
Mant Jonathan,
Farmer Andrew J.,
Kinmonth Ann Louise
Publication year - 2013
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.113.000251
Subject(s) - medicine , blood pressure , stroke (engine) , randomized controlled trial , meta analysis , psychological intervention , cinahl , clinical trial , physical therapy , medline , psycinfo , psychiatry , mechanical engineering , political science , law , engineering
Background 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. Methods and Results We searched MEDLINE , EMBASE , CINAHL , BNI , Psyc INFO , 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 RCT s 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. Conclusions 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.