Efficacy of a brief multifactorial adherence-based intervention on reducing the blood pressure of patients with poor adherence: protocol for a randomized clinical trial.
BACKGROUND
Lowering of blood pressure by antihypertensive drugs reduces the risks of cardiovascular events, stroke, and total mortality. However, poor adherence to antihypertensive medications reduces their effectiveness and increases the risk of adverse events. In terms of relative risk reduction, an improvement in medication adherence could be as effective as the development of a new drug.


METHODS
The proposed randomized controlled trial will include patients with a low adherence to medication and uncontrolled blood pressure. The intervention group will receive a multifactorial intervention during the first, third, and ninth months, to improve adherence. This intervention will include motivational interviews, pill reminders, family support, blood pressure self-recording, and simplification of the dosing regimen.


METHODS
The primary outcome is systolic blood pressure. The secondary outcomes are diastolic blood pressure, proportion of patients with adequately controlled blood pressure, and total cost.


CONCLUSIONS
The trial will evaluate the impact of a multifactorial adherence intervention in routine clinical practice. Ethical approval was given by the Ethical Committee on Human Research of Balearic islands, Spain (approval number IB 969/08 PI).
Leiva
Alfonso
A
Primary Care Research Unit of Mallorca, Baleares Health services-IbSalut, CAIBER, Mallorca, Spain. aleiva@ibsalut.caib.es
Fajó
Marta
M
Escriche
Luís
L
Audera
Francisco J
FJ
López
Sara
S
Martín
Ma Carmén
MC
González
Rosa
R
Tamborero
Gaspar
G
García
Elena M
EM
Duro
Rosa
R
Orueta
Ramón
R
Serra
Francisca
F
D'agosto P
Pilar
P
Miralles
Jerónima
J
Lorente
Patricia
P
Llobera
Joan
J
Iglesias
Ana Aurelia
AA
Fernández
Ruth
R
Colom
María M
MM
Buades
Aina M
AM
Moreno
Lucía
L
Vidal
Clara
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D001795:Blood Pressure Determination; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology / Q000523:psychology; D007406:Interview, Psychological; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D009042:Motivation; D012107:Research Design; D012306:Risk; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome; D016903:Drug Monitoring
D000959:Antihypertensive Agents