Tailored interventions to improve adherence to antihypertensive treatment and reduce blood pressure: findings from a systematic review and meta-analysis

Abstract Introduction Adherence is defined as "the extent to which an individual’s behaviour – taking medication, following a diet, and/or making lifestyle changes - is consistent with agreed recommendations from a health care provider" [1]. Despite the availability of effective pharmacological and lifestyle interventions to lower blood pressure (BP), non-adherence to antihypertensive treatment remains one of the major causes of inadequate BP control and, in consequence, of increased risk of cardiovascular events worldwide. [2] Tailored interventions (TIs) may be particularly useful in this context. TIs to improve adherence are defined as personalized interventions designed to help individuals to follow medical recommendations, according to their specific clinical and psychosocial characteristics. [3] Purpose: the main objective of this study was to perform a systematic review and meta-analysis of the existing evidence on the effectiveness of digital and non-digital TIs in improving adherence to lifestyle and medication recommendations and in lowering BP in patients with hypertension. Method A systematic search on PubMed, Medline, Scopus, EMBASE, Web of Science, and EBSCO included randomized controlled trials on TIs for hypertension published in English language up to May 2024. Different combinations of keywords, including hypertension, tailored intervention, personalization, adherence and rehabilitation, were used in the search; two reviewers independently screened the retrieved records and identified the eligible papers. Studies reporting BP (as an indirect indicator of adherence) or adherence assessed with validated questionnaires. The between-group mean difference in BP or in standardized adherence score at the end of follow-up was the measure of interest. Results Of the 622 papers identified in the databases, 228 duplicates were removed. After the title/abstract screening and reading the full text, 22 were considered for the quality assessment. Of these 6 were excluded because of missing data on BP or adherence. Of the remaining 16 studies, 11 had BP as an outcome measure and 8 had adherence as an outcome measure. Systolic and diastolic BP at follow-up was lower in the TI group by 1.62[95% CI 0.02-3.21] mmHg and 0.98[0.12-1.84], respectively, compared to control. Questionnaire-based adherence tended to be higher with TIs without reaching statistical significance.(Figure) In stratified analyses effect of TIs on BP was only present in studies with follow-up less than 6 months. No significant heterogeneity according to sex or ethnicity was observed. Conclusion Our meta-analysis suggests that although TIs may have a positive effect on short-term reductions in SBP and on self-reported adherence, the beneficial effect is modest and long-term sustainability of these effects is limited.Figure 1