title: Trials to improve blood pressure through adherence to antihypertensives in stroke/TIA: systematic review and meta-analysis.
abstract: 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.
  
  
  RESULTS
  We searched MEDLINE, EMBASE, CINAHL, BNI, PsycINFO, 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 RCTs 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.
authors: The Primary Care Unit, University of Cambridge, United Kingdom.
authors: Anna
authors: A
authors: De Simoni
authors: Wendy
authors: W
authors: Hardeman
authors: Jonathan
authors: J
authors: Mant
authors: Andrew J
authors: AJ
authors: Farmer
authors: Ann Louise
authors: AL
authors: Kinmonth
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D055118:Medication Adherence; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; hypertension; prevention; stroke
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