Document Detail

Monitoring adherence to medication by measuring change in blood pressure.
MedLine Citation:
PMID:  20696980     Owner:  NLM     Status:  MEDLINE    
After starting antihypertensives, blood pressure is monitored for several reasons, including assessment of adherence. We aimed to estimate the accuracy of blood pressure monitoring for detecting early nonadherence. We conducted a secondary analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a large randomized trial of blood pressure lowering to reduce the risk of recurrent stroke. We compared change in blood pressure 3 months after randomization in people who had discontinued treatment (nonadherent) with those who stayed on treatment (adherent). We also used an indirect method, assessing whether change in blood pressure discriminated between active (adherent) and placebo (nonadherent) groups. Both methods gave similar results. For the 3433 subjects, the mean (SD) of the change in systolic blood pressure was -15.8 mm Hg (SD 18.7 mm Hg) in the adherent group and -4.2 mm Hg (SD 18.1 mm Hg) in the nonadherent group. After recalibration of the mean change in the nonadherent group to 0 mm Hg and in the adherent group to -11.6 mm Hg, the absence of a fall in systolic blood pressure at 3 months had a sensitivity of 50% and a specificity of 80% for detecting nonadherence (50% of nonadherent patients and 20% of adherent patients had a rise in blood pressure). Discriminatory power was modest over the range of cutoffs (area under the receiver-operator curve 0.67). Monitoring blood pressure is poor at detecting nonadherence to blood pressure-lowering treatment. Further research should look at other methods of assessing adherence.
Andrew Hayen; Katy Bell; Paul Glasziou; Bruce Neal; Les Irwig
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-08-09
Journal Detail:
Title:  Hypertension     Volume:  56     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-16     Completed Date:  2010-10-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  612-6     Citation Subset:  IM    
Sydney School of Public Health A27, University of Sydney, Sydney, NSW 2006, Australia.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Blood Pressure / drug effects*
Diuretics / therapeutic use
Drug Monitoring / methods
Drug Therapy, Combination
Follow-Up Studies
Hypertension / drug therapy*,  physiopathology
Indapamide / therapeutic use*
Patient Compliance
Perindopril / therapeutic use*
Stroke / prevention & control
Treatment Outcome
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Diuretics; 26807-65-8/Indapamide; 82834-16-0/Perindopril

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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