Multicomponent intervention for improving medication adherence in hypertension falls short

A primary care–based multicomponent intervention helps identify patients with antihypertensive medication nonadherence but does not result in improvements in adherence or blood pressure (BP), as reported in a study.

Researchers conducted a pragmatic, cluster randomized clinical trial and enrolled 1,726 adult patients (mean age 67.2 years, 51.4 percent female) with uncontrolled hypertension and low medication adherence, defined as proportion of days covered (PDC) being less than 80 percent.

The participants were randomly assigned to undergo either a primary care–based multicomponent intervention or usual care. The intervention comprised the following: (1) automated identification of patients with medication nonadherence at the time of the visit; (2) prompting of medical assistants to screen for barriers to adherence; (3) clinical decision support alerting the primary care physicians and nurse practitioners to barriers to adherence; and (4) adherence discussion between the primary care physician or nurse practitioner and the patient.

The primary outcome of PDC increased from 32.4 percent at baseline to 51.1 percent at 12 months in the intervention group and from 34.0 percent to 53.1 percent in the control group. The mean absolute change in PDC over 12 months did not significantly differ between the intervention and the control groups (18.5 vs 18.2 percentage points, respectively; adjusted difference, −0.15 percentage point).

Changes in systolic blood pressure and the number of patients who became adherent (PDC ≥80 percent) at 12 months were also comparable between the two groups.