Trials to improve blood pressure through adherence to antihypertensives in stroke/TIA: systematic review and meta-analysis.

The purpose of this study was to determine whether interventions including components to improve adherence to antihypertensive medications in patients after stroke/transient ischemic attack (tia) improve adherence and blood pressure control. we searched medline,embase,cinahl,bni,psycinfo,and article reference lists to october 2012. search terms included stroke/tia,adherence/prevention,hypertension,and randomized controlled trial (rct). inclusion criteria were participants with stroke/tia; interventions including a component to improve adherence to antihypertensive medications; and outcomes including blood pressure,antihypertensive adherence,or both. two reviewers independently assessed studies to determine eligibility,validity,and quality. seven rcts were eligible (n=1591). methodological quality varied. all trials tested multifactorial interventions. none targeted medication adherence alone. six trials measured blood pressure and 3 adherence. meta-analysis of 6 trials showed that multifactorial programs were associated with improved blood pressure control. the difference between intervention versus control in mean improvement in systolic blood pressure was -5.3 mm hg (95% ci,-10.2 to -0.4 mm hg,p=0.035; i(2)=67% [21% to 86%]) and in diastolic blood pressure was -2.5 mm hg (-5.0 to -0.1 mm hg,p=0.046; i(2)=47% [0% to 79%]). there was no effect on medication adherence where measured. multifactorial interventions including a component to improve medication adherence can lower blood pressure after stroke/tia. however,it is not possible to say whether or not this is achieved through better medication adherence. trials are needed of well-characterized interventions to improve medication adherence and clinical outcomes with measurement along the hypothesized causal pathway.