title: Efficacy of a brief multifactorial adherence-based intervention in reducing blood pressure: a randomized clinical trial.
abstract: BACKGROUND
  Lowering blood pressure (BP) by antihypertensive (AHT) drugs reduces the risks of cardiovascular events, stroke, and total mortality. However, poor adherence to AHT medications reduces their effectiveness and increases the risk of adverse events.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a multifactorial adherence-based intervention in a primary care setting in lowering BP.
  
  
  METHODS
  Multicenter parallel randomized controlled trial. Thirty two nurses in 28 primary care centers of three Spanish regions. Patients aged 18-80 years, taking AHT drugs with uncontrolled BP (n=221) were randomized to a control group (usual care) or a multifactorial adherence-based intervention including nurse-led motivational interviews, pill reminders, family support, BP self-recording, and simplification of the dosing regimen by a pharmacist.
  
  
  METHODS
  The primary outcome was 12-month blinded measure of systolic BP (mean of three measurements). The secondary outcomes were 12-month diastolic BP and proportion of patients with adequately controlled BP.
  
  
  RESULTS
  One hundred and fourteen patients were allocated to the intervention group and 109 to the control group. At 12 months, 212 (89%) participants completed the study. The systolic BP in the intervention group was 151.3 versus 153.7 in the control group (P=0.294). The diastolic BP did not differ between groups (83.4 versus 83.6). Of the patients in the control group, 9.2% achieved BP control versus a 15.8% in the intervention group. The relative risk for achieving BP control was 1.72 (95% confidence interval: 0.83-3.56).
  
  
  CONCLUSIONS
  A multifactorial intervention based on improving adherence in patients with uncontrolled hypertension failed to find evidence of effectiveness in lowering systolic BP.
  
  
  BACKGROUND
  ISRCTN21229328.
authors.affiliation: Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Mallorca, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Leiva
authors.affiliation: Research Group on Evidence, Lifestyles and Health, Universitat Illes Balears, Palma, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Aguiló
authors.affiliation: Faculty of Health and Sport Sciences, University of Zaragoza, Huesca, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Fajó-Pascual
authors.affiliation: Son Cladera Health Centre, Baleares Health Services-IbSalut, Mallorca, Spain.
authors.forename: Lucia
authors.initials: L
authors.lastname: Moreno
authors.affiliation: Actur Sur Health Centre, Aragon Health Services-Salud, Aragón, Zaragoza, Spain.
authors.forename: M Carmen
authors.initials: MC
authors.lastname: Martín
authors.affiliation: Coll D'en Rabassa Health Centre, Baleares Health Services-IbSalut, Mallorca, Spain.
authors.forename: Elena Marina
authors.initials: EM
authors.lastname: Garcia
authors.affiliation: San Agustín Health Centre, Baleares Health Services-IbSalut, Mallorca, Spain.
authors.forename: Rosa Elena
authors.initials: RE
authors.lastname: Duro
authors.affiliation: Santa María Health Centre, Baleares Health Services-IbSalut, Mallorca, Spain.
authors.forename: Francisca
authors.initials: F
authors.lastname: Serra
authors.affiliation: Sineu Health Centre, Baleares Health Services-IbSalut, Mallorca, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Dagosto
authors.affiliation: Santa Ponça Health Centre, Baleares Health Services-IbSalut, Mallorca, Spain.
authors.forename: Ana Aurelia
authors.initials: AA
authors.lastname: Iglesias-Iglesias
authors.affiliation: Department of Pharmacy, Manacor Hospital-Llevant Sector, Baleares Health Services-IbSalut, Mallorca, Spain.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Company
authors.affiliation: Montuiri Health Centre, Baleares Health Services-IbSalut, Mallorca, Spain.
authors.forename: Aina
authors.initials: A
authors.lastname: Yañez
authors.affiliation: Fundació d'Investigació Sanitaria Illes Balears (FISIB), Son Espases Hospital, Baleares Health Services-IbSalut, Mallorca, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Llobera
keywords: blood pressure; hypertension; intervention studies; medication adherence