Adherence to antihypertensive drug treatment in Brazil: a systematic review and meta-analysis. / Adesão ao tratamento medicamentoso anti-hipertensivo no Brasil: revisão sistemática e meta-análise.

This article aims to evaluate the adherence to antihypertensive treatment prevalence in the Brazilian population based on peer-reviewed studies which used instruments exclusively designed and/or adapted for this purpose. A systematic review with meta-analysis based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was carried out in the BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, and MEDLINE databases, as well as the AgeLine, Google Scholar and ScienceDirect academic search engines. The protocol was registered with PROSPERO (CRD42021292689). Random effects models were used for a meta-analysis of the prevalence obtained from individual studies. A total of 104 studies were included in the meta-analysis on antihypertensive treatment in the Brazilian population, totaling 38,299 patients. The most used instrument was the four-item Morisky-Green Test (49.5%). The adherence prevalence estimated by the meta-analysis was 44.4% (95%CI: 39.12%-49.94%, I2 = 91.17, p < 0.001), showing high heterogeneity. The adherence to antihypertensive treatment prevalence found in national studies was unsatisfactory, demonstrating that this problem continues to be a major challenge.

O objetivo do artigo é avaliar a prevalência de adesão ao tratamento anti-hipertensivo na população brasileira, com base nos estudos revisados por pares, que utilizaram instrumentos elaborados e/ou adaptados exclusivamente para este fim. Revisão sistemática com meta-análise, baseada nas recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca foi realizada nas bases BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, MEDLINE, e nos buscadores acadêmicos AgeLine, Google Scholar e ScienceDirect. O protocolo foi registrado no PROSPERO (CRD42021292689). Modelos de efeitos aleatórios foram usados para meta-análise das prevalências obtidas dos estudos individuais. Incluíram-se 104 estudos na meta-análise sobre tratamento anti-hipertensivo na população brasileira, totalizando 38.299 pacientes. O instrumento mais utilizado foi o teste de Morisky-Green de quatro itens (49,5%). A prevalência de adesão estimada pela foi de 44,4% (IC95%: 39,12%-49,94%, I2 = 91,17, p < 0,001), apresentando alta heterogeneidade. A prevalência de adesão ao tratamento anti-hipertensivo encontrada nos estudos nacionais foi insatisfatória, demonstrando que essa problemática continua sendo um grande desafio.

Adesão ao tratamento medicamentoso anti-hipertensivo no Brasil: revisão sistemática e meta-análise / Adherence to antihypertensive drug treatment in Brazil: a systematic review and meta-analysis

Resumo O objetivo do artigo é avaliar a prevalência de adesão ao tratamento anti-hipertensivo na população brasileira, com base nos estudos revisados por pares, que utilizaram instrumentos elaborados e/ou adaptados exclusivamente para este fim. Revisão sistemática com meta-análise, baseada nas recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca foi realizada nas bases BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, MEDLINE, e nos buscadores acadêmicos AgeLine, Google Scholar e ScienceDirect. O protocolo foi registrado no PROSPERO (CRD42021292689). Modelos de efeitos aleatórios foram usados para meta-análise das prevalências obtidas dos estudos individuais. Incluíram-se 104 estudos na meta-análise sobre tratamento anti-hipertensivo na população brasileira, totalizando 38.299 pacientes. O instrumento mais utilizado foi o teste de Morisky-Green de quatro itens (49,5%). A prevalência de adesão estimada pela foi de 44,4% (IC95%: 39,12%-49,94%, I2 = 91,17, p < 0,001), apresentando alta heterogeneidade. A prevalência de adesão ao tratamento anti-hipertensivo encontrada nos estudos nacionais foi insatisfatória, demonstrando que essa problemática continua sendo um grande desafio.

Abstract This article aims to evaluate the adherence to antihypertensive treatment prevalence in the Brazilian population based on peer-reviewed studies which used instruments exclusively designed and/or adapted for this purpose. A systematic review with meta-analysis based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was carried out in the BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, and MEDLINE databases, as well as the AgeLine, Google Scholar and ScienceDirect academic search engines. The protocol was registered with PROSPERO (CRD42021292689). Random effects models were used for a meta-analysis of the prevalence obtained from individual studies. A total of 104 studies were included in the meta-analysis on antihypertensive treatment in the Brazilian population, totaling 38,299 patients. The most used instrument was the four-item Morisky-Green Test (49.5%). The adherence prevalence estimated by the meta-analysis was 44.4% (95%CI: 39.12%-49.94%, I2 = 91.17, p < 0.001), showing high heterogeneity. The adherence to antihypertensive treatment prevalence found in national studies was unsatisfactory, demonstrating that this problem continues to be a major challenge.

Adherence to antihypertensive treatment during the COVID-19 pandemic: findings from a cross-sectional study.

BACKGROUND: Nonadherence to antihypertensive treatment is one of the main causes of the lack of blood pressure (BP) control. The coronavirus disease (COVID-19) pandemic imposes substantial social restriction impairing the medical care routine, which may influence adherence to the antihypertensive treatment. To assess the rate of nonadherence to antihypertensive drug treatment during the COVID-19 pandemic. METHODS: This is a cross-sectional study evaluating hypertensive adult patients from a tertiary outpatient clinic. From March to August 2020, patients were interviewed by telephone during the social distancing period of the COVID-19 pandemic. We evaluated biosocial data, habits, attitudes, and treatment adherence using the 4-item Morisky Green Levine Scale during the social distancing. Uncontrolled BP was defined by BP ≥ 140/90 mmHg. Clinical and prescription variables for drug treatment were obtained from the electronic medical record. We performed a multivariate analysis to determine the predictors of nonadherence to BP treatment. RESULTS: We studied 281 patients (age 66 ± 14 years, 60.5% white, 62.3% women, mean education of 9.0 ± 4 years of study). We found that 41.3% of the individuals reported poor adherence to antihypertensive drug treatment and 48.4% had uncontrolled BP. Subsample data identified that adherence was worse during the pandemic than in the previous period. The variables that were independently associated with the nonadherence during the pandemic period were black skin color (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.46-4.68), and intermittent lack of access to antihypertensive medication during the pandemic (OR, 2.56; 95% CI, 1.11-5.89). CONCLUSIONS: Beyond traditional variables associated with poor adherence, the lack of availability of antihypertensive medications during the study underscore the potential role of pandemic on hypertension burden.