Una revisión sistemática de la adherencia al tratamiento antihipertensivo y de las intervenciones destinadas a mejorarla

Abstract

Hypertension is nowadays considered one of the major public health problems due to its contribution as a risk factor for cardiovascular diseases. Therapeutic adherence is a factor that affects the degree of control of hypertension, and this is due to multiple variables. Observational studies suggest that there are differences in therapeutic adherence depending on the antihypertensive drug. Also, clinical trials outline various interventions of variable effectiveness to improve the control of hypertension. Our objective was to assess the association between adherence and drug class, as well as to analyze the most effective interventions to improve the control of hypertension. A systematic review identified 38 observational studies to assess adherence, and 85 clinical trials to study the types of interventions. Adherence was measured as a compliance risk (OR and HR) between pairs of drug classes and the types of covariates included in the adjusted analysis. We only selected studies that would have measured adherence using prescriptions collection databases. For the meta-analysis of the interventions, effect size indexes were found using Hedges' typified mean of blood pressure by calculating the difference between the post and pre-intervention means of each group divided by the typical pre-intervention standard deviation. The biggest adherence to antihypertensive drugs is significantly associated with samples from older, white, diabetic, non-depressed patients taking angiotensin II receptor antagonists, angiotensin converting enzyme inhibitors, and a fixed combination of antihypertensive regimen. The smallest adherence was obtained from samples of patients taking diuretics. The most effective interventions are the following: educational type or those which have an educational component, behavioral type, those offering incentives, those with a unique component, those based on a theory, those offered face to face, and those developed at the office and at home simultaneously