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Blood pressure outcomes of medication adherence interventions: systematic review and meta-analysis

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Abstract

This systematic review applied meta-analytic procedures to integrate primary research that examined blood pressure outcomes of medication adherence interventions. Random-effects model analysis calculated standardized mean difference effect sizes. Exploratory dichotomous and continuous moderator analyses using meta-analytic analogues of ANOVA and regression were performed. Codable data were extracted from 156 reports with 60,876 participants. The overall weighted mean difference systolic effect size was 0.235 across 161 treatment versus control comparisons. The diastolic effect size was 0.189 from 181 comparisons. Effect sizes were significantly heterogeneous. Common risks of bias included lack of allocation concealment, unmasked data collectors, and absent intention-to-treat analyses. Exploratory moderator analyses suggested that habit-based interventions may be most effective. The largest effect sizes were for interventions delivered by pharmacists. The modest magnitude effect sizes suggest future research should explore novel higher dose interventions that might address multiple levels of influence on adherence behavior.

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Acknowledgments

The project was funded by the American Heart Association (13GRNT16550001) and the National Institutes of Health (R01NR011990). The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Heart Association or the National Institutes of Health.

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Authors and Affiliations

  1. School of Nursing, University of Missouri, S317 Sinclair Building, Columbia, MO, 65211, USA

    Vicki S. Conn

  2. University of Missouri, S423 Sinclair Building, Columbia, MO, 65211, USA

    Todd M. Ruppar

  3. University of Missouri, S343 Sinclair Building, Columbia, MO, 65211, USA

    Jo-Ana D. Chase

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  1. Vicki S. Conn
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  2. Todd M. Ruppar
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Correspondence to Vicki S. Conn.

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Vicki S. Conn, Todd M. Ruppar and Jo-Ana D. Chase declare that they have no conflict of interest.

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Conn, V.S., Ruppar, T.M. & Chase, JA.D. Blood pressure outcomes of medication adherence interventions: systematic review and meta-analysis. J Behav Med 39, 1065–1075 (2016). https://doi.org/10.1007/s10865-016-9730-1

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