Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy
National Centre for Healthcare Research and Pharmacoepidemiology, University of Milan-Bicocca, Milan, Italy.
BMJ Open. 2020 Jul 8;10(7):e036418. doi: 10.1136/bmjopen-2019-036418.
Poor worldwide rate of blood pressure control is largely due to poor adherence to antihypertensive (AHT) drug treatment. The question of whether sex affects adherence has long been debated but conflicting findings have been reported on this issue. Our objective was to evaluate sex differences in the adherence to AHT therapy.
Studies were identified through a systematic search of PubMed, CINAHL, PsycINFO, Web of Science and Google Scholar (through January 2020) and manual handsearching of relevant articles. Observational studies reporting adherence to AHT drugs measured by self-report or pharmacy refill prescription-based methods among men and women were included. Summarised estimates of OR with 95% CIs were calculated using random-effects model and meta-regression models.
From 12 849 potentially relevant publications, 82 studies (15 517 457 men and 18 537 599 women) were included. No significant between-sex differences in adherence to AHT were observed, whether all study-specific estimates were summarised (OR 1.04, 95% CI 1.00 to 1.09, p=0.07), nor estimates were pooled according to the method for measuring adherence. Among patients aged 65 years or older, lower self-reported adherence was observed in women (OR 0.84, 95% CI 0.72 to 0.97, p=0.02), while the main result remained unchanged according to other subgroup analyses.
Definitive evidence of sex differences in adherence to AHT therapy cannot be drawn. Our little knowledge about factors affecting adherence, in particular of sex effect among elderly, urgently requires high-quality studies investigating these issues.
全球范围内血压控制率较差主要是由于抗高血压（AHT）药物治疗的依从性较差。关于性别是否会影响依从性的问题由来已久，但对此问题的研究结果存在冲突。我们的目的是评估 AHT 治疗依从性的性别差异。
通过系统检索 PubMed、CINAHL、PsycINFO、Web of Science 和 Google Scholar（截至 2020 年 1 月）以及手动检索相关文章，确定了研究。纳入了报告通过自我报告或基于药房补药处方的方法测量男性和女性对 AHT 药物的依从性的观察性研究。使用随机效应模型和荟萃回归模型计算汇总估计的 OR 及其 95%CI。
从 12849 篇可能相关的文献中，纳入了 82 项研究（15517457 名男性和 18537599 名女性）。无论汇总所有研究特定估计值（OR 1.04，95%CI 1.00 至 1.09，p=0.07），还是根据测量依从性的方法进行汇总估计值，均未观察到性别之间对 AHT 的依从性存在显著差异。在年龄在 65 岁或以上的患者中，女性自我报告的依从性较低（OR 0.84，95%CI 0.72 至 0.97，p=0.02），而根据其他亚组分析，主要结果保持不变。
不能得出关于 AHT 治疗依从性存在性别差异的明确证据。我们对影响依从性的因素，尤其是对老年患者的性别影响的了解甚少，迫切需要高质量的研究来调查这些问题。
