Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
University of Ottawa, Ottawa, Ontario, Canada.
Am J Hypertens. 2023 Jun 15;36(7):394-403. doi: 10.1093/ajh/hpad013.
The prevalence of medication nonadherence in the setting of resistant hypertension (RH) varies from 5% to 80% in the published literature. The aim of this systematic review was to establish the overall prevalence of nonadherence and evaluate the effect of the method of assessment on this estimate.
MEDLINE, EMBASE, Cochrane, CINAHL, and Web of Science (database inception to November 2020) were searched for relevant articles. We included studies including adults with a diagnosis of RH, with some measure of adherence. Details about the method of adherence assessment were independently extracted by 2 reviewers. Pooled analysis was performed using the random effects model and heterogeneity was explored with metaregression and subgroup analyses. The main outcome measured was the pooled prevalence of nonadherence and the prevalence using direct and indirect methods of assessment.
Forty-two studies comprising 71,353 patients were included. The pooled prevalence of nonadherence was 37% (95% confidence interval [CI] 27%-47%) and lower for indirect methods (20%, 95% CI 11%-35%), than for direct methods (46%, 95% CI 40%-52%). The study-level metaregression suggested younger age and recent publication year as potential factors contributing to the heterogeneity.
Indirect methods (pill counts or questionnaires) are insufficient for diagnosis of nonadherence, and report less than half the rates as direct methods (direct observed therapy or urine assays). The overall prevalence of nonadherence in apparent treatment RH is extremely high and necessitates a thorough evaluation of nonadherence in this setting.
在耐药性高血压（RH）的情况下，药物不依从的发生率在文献中从 5%到 80%不等。本系统评价的目的是确定不依从的总体发生率，并评估评估方法对该估计值的影响。
在 MEDLINE、EMBASE、Cochrane、CINAHL 和 Web of Science（数据库建立至 2020 年 11 月）中搜索相关文章。我们纳入了诊断为 RH 的成年患者，并使用某种依从性测量方法的研究。由 2 位审阅者独立提取关于依从性评估方法的详细信息。使用随机效应模型进行汇总分析，并使用元回归和亚组分析探索异质性。主要结局测量是不依从的汇总发生率和直接和间接评估方法的发生率。
共纳入 42 项研究，包含 71353 名患者。不依从的总体发生率为 37%（95%置信区间 [CI] 27%-47%），间接方法（20%，95%CI 11%-35%）的发生率低于直接方法（46%，95%CI 40%-52%）。研究水平的荟萃回归表明，年龄较小和最近的发表年份可能是导致异质性的因素。
间接方法（计数药丸或问卷调查）不足以诊断不依从，报告的比率低于直接方法（直接观察治疗或尿液检测）的一半。在明显治疗 RH 中不依从的总体发生率极高，因此需要在这种情况下对不依从进行彻底评估。
