Morrissey Eimear C, Durand Hannah, Nieuwlaat Robby, Navarro Tamara, Haynes R Brian, Walsh Jane C, Molloy Gerard J
a School of Psychology, National University of Ireland , Galway , Ireland.
b Department of Clinical Epidemiology and Biostatistics , McMaster University , Hamilton , Canada.
Psychol Health. 2017 Oct;32(10):1195-1232. doi: 10.1080/08870446.2016.1273356. Epub 2017 Jan 27.
The objective of this systematic review is to evaluate the effectiveness of medication adherence interventions on blood pressure control in hypertensive patients. In addition, we aim to explore what barriers and facilitators in the interventions may have been targeted and how these might be related to the effect size on blood pressure (BP).
This review is a hypertension-specific update to the previous Cochrane Review by Nieuwlaat et al. ( 2014 ) on interventions to enhance medication adherence. A systematic literature search was carried out and two authors independently screened titles and abstracts for their eligibility for inclusion and independently extracted data from the selected studies and assessed the methodological quality using the Cochrane Collaboration Risk of Bias Tool. A meta-analysis was conducted and additionally, theoretical factors in interventions were identified using the Theoretical Domains Framework.
The meta-analysis found a modest main effect of adherence interventions on SBP (MD -2.71 mm Hg, 95% CI -4.17 to -1.26) and DBP (MD -1.25 mm Hg, 95% CI -1.72 to -.79). However, there was substantial significant heterogeneity across both outcomes. A narrative review on adherence outcomes was conducted. In terms of the theoretical analysis, the relationship between the total number of times the domains were coded within an intervention and change of SBP (r = -.234, p = .335) and DBP was not significant (r = -.080, p = .732). Similarly, the relationship between the total number of times different domains were coded within an intervention and change of SBP (r = .080, p = .746) and DBP was not significant (r = -.188, p = .415).
This review and meta-analysis of interventions documented significant but modest post-intervention improvements in BP outcomes among hypertensive patients. However, this is a tentative finding as substantial heterogeneity and potential biases were present. One of the greatest challenges of this review was assessing risk of bias, extracting sufficient data to calculate effect size and coding interventions with the amount of information provided in papers. It is imperative that future adherence research comprehensively reports methodology.
本系统评价的目的是评估药物依从性干预措施对高血压患者血压控制的有效性。此外，我们旨在探讨干预措施中的哪些障碍因素和促进因素可能是目标对象，以及这些因素与血压效应大小之间可能存在怎样的关联。
本评价是对Nieuwlaat等人（2014年）之前关于提高药物依从性干预措施的Cochrane系统评价的高血压专题更新。进行了系统的文献检索，两位作者独立筛选标题和摘要以确定其纳入资格，并独立从选定研究中提取数据，使用Cochrane协作偏倚风险工具评估方法学质量。进行了荟萃分析，此外，使用理论领域框架确定干预措施中的理论因素。
荟萃分析发现依从性干预措施对收缩压有适度的主要影响（平均差-2.71mmHg，95%置信区间-4.17至-1.26），对舒张压也有适度的主要影响（平均差-1.25mmHg，95%置信区间-1.72至-0.79）。然而，这两个结果均存在显著的异质性。对依从性结果进行了叙述性综述。在理论分析方面，干预措施中各领域被编码的总次数与收缩压变化之间的关系不显著（r = -0.234，p = 0.335），与舒张压变化之间的关系也不显著（r = -0.080，p = 0.732）。同样，干预措施中不同领域被编码的总次数与收缩压变化之间的关系不显著（r = 0.080，p = 0.746），与舒张压变化之间的关系也不显著（r = -0.188，p = 0.415）。
本对干预措施的综述和荟萃分析表明，高血压患者干预后血压结果有显著但适度的改善。然而，这是一个初步发现，因为存在显著的异质性和潜在偏倚。本综述最大的挑战之一是评估偏倚风险、提取足够的数据以计算效应大小，以及根据论文提供的信息量对干预措施进行编码。未来的依从性研究必须全面报告方法学。
