Nonadherence to antihypertensive drugs: A systematic review and meta-analysis.
Nonadherence to antihypertensive drugs: A systematic review and meta-analysis.
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DOI：
10.1097/md.0000000000005641
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发表时间：
2017-01
期刊：
影响因子：
1.6
通讯作者：
Elnour AA
中科院分区：
文献类型：
--
作者：
Abegaz TM;Shehab A;Gebreyohannes EA;Bhagavathula AS;Elnour AA
补充数字内容可在《高血压导致全球心血管疾病的负担》一文中获得，据估计，到2025年，其患病率将增加30%。不遵守长期服药方案是很常见的；不遵守处方方案的患者中，大约43%到65.5%是高血压患者。不坚持服药是导致伴随疾病发生的一个潜在因素。这项系统性综述应用荟萃分析方法调查成人高血压患者的药物不依从性。最初的研究是在成年高血压患者身上进行的，使用8个条目的Morisky药物依从性量表(MMAS-8)来评估2009年1月至2016年3月期间的药物依从性。采用3个数据库的综合检索策略和MESH关键词检索符合条件的文献。记录研究特征、参与者人口统计和服药依从性结果。结果的效应大小被计算为标准化的平均差异，使用随机效应模型来估计总体平均效应。共确定了来自15个国家的28项研究，总共包括13,688名高血压患者。在涉及12,603名受试者的25项研究中，相当数量(45.2%)的高血压患者和三分之一(31.2%)的高血压患者(31.2%)不遵守药物治疗。然而，在血压不受控制的患者中，发现更高比例的药物不依从性(83.7%)。尽管女性不坚持服用降压药的比例较高(54%)(P <； 0.001)，但男性不坚持的风险是男性的1.3%，相对风险为0.883。总体而言，近三分之二(62.5%)的用药不依从性发生在非洲人和亚洲人(43.5%)。在研究的受试者中，有45%的受试者没有坚持服用降压药，而未控制血压的受试者中，有更高比例(83.7%)不坚持服药。应重视旨在提高依从性的干预模式。
Supplemental Digital Content is available in the text Hypertension drives the global burden of cardiovascular disease and its prevalence is estimated to increase by 30% by the year 2025. Nonadherence to chronic medication regimens is common; approximately 43% to 65.5% of patients who fail to adhere to prescribed regimens are hypertensive patients. Nonadherence to medications is a potential contributing factor to the occurrence of concomitant diseases. This systematic review applied a meta-analytic procedure to investigate the medication nonadherence in adult hypertensive patients. Original research studies, conducted on adult hypertensive patients, using the 8-item Morisky medication adherence scale (MMAS-8) to assess the medication adherence between January 2009 and March 2016 were included. Comprehensive search strategies of 3 databases and MeSH keywords were used to locate eligible literature. Study characteristics, participant demographics, and medication adherence outcomes were recorded. Effect sizes for outcomes were calculated as standardized mean differences using random-effect model to estimate overall mean effects. A total of 28 studies from 15 countries were identified, in total comprising of 13,688 hypertensive patients, were reviewed. Of 25 studies included in the meta-analysis involving 12,603 subjects, a significant number (45.2%) of the hypertensive patients and one-third (31.2%) of the hypertensive patients with comorbidities were nonadherent to medications. However, a higher proportion (83.7%) of medication nonadherence was noticed in uncontrolled blood pressure (BP) patients. Although a higher percentage (54%) of nonadherence to antihypertensive medications was noticed in females (P < 0.001), the risk of nonadherence was 1.3 times higher in males, with a relative risk of 0.883. Overall, nearly two-thirds (62.5%) of the medication nonadherence was noticed in Africans and Asians (43.5%). Nonadherence to antihypertensive medications was noticed in 45% of the subjects studied and a higher proportion of uncontrolled BP (83.7%) was nonadherent to medication. Intervention models aiming to improve adherence should be emphasized.