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Interventions that improve adherence to antihypertensive medications in coronary heart disease patients: a systematic review
  1. Jialin Hong1,
  2. Yuen Chak Tiu1,
  3. Po Yat Bowie Leung1,
  4. Man Fai Wong1,
  5. Wing Yan Ng1,
  6. Dawn Cheung1,
  7. Hiu Yan Mok1,
  8. Wai Yan Lam1,
  9. Kwan Yu Li1,
  10. Carlos KH Wong2,3
  1. 1University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
  2. 2Family Medicine and Primary Care, University of Hong Kong, Hong Kong, Hong Kong
  3. 3Pharmacology and Pharmacy, University of Hong Kong, Hong Kong, Hong Kong
  1. Correspondence to Jialin Hong, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong; hong1997{at}


A systematic review is conducted to identify effective interventions that improved adherence to antihypertensive drugs among patients with coronary heart diseases (CHDs). Primary studies designed to measure interventions to improve adherence on antihypertensive drugs in patients with CHD were included. Three online databases, COCHRANE, EMBASE and MEDLINE, were searched for primary studies published in English from 2005 to 2019. Studies were screened independently for eligibility. Cochrane risk-of-bias tool and the Newcastle-Ottawa Scale were used for quality assessment of randomised controlled trials (RCTs) and non-randomised studies, respectively. Of the 2000 entries identified, seven articles, including one cross-sectional study and six RCTs, met the inclusion criteria and were reviewed. One of the articles evaluated two interventions, so eight interventions were evaluated in total. Quality of the included studies was generally high, with the cross-sectional study rated as having good quality under Newcastle-Ottawa Scale, while four and two RCTs were rated as having low and some risk of bias under Cochrane risk-of-bias tool, respectively. Six of the intervention programmes were considered effective. An intervention was considered effective if it is associated with a significant (p≤0.05) and non-trivial (Cohen’s d≥0.2) improvement in compliance-related outcomes such as in terms of the Morisky 8-item Medication Adherence Scale. Medication education, disease education, health education, constant reminders and medications dispensed using blister packs were identified to be effective in improving patients’ compliance to medications. The importance of the continuity of interventions was also established. It is recommended that health service institutions should provide continuous education programmes, daily reminders and regular follow-ups for their patients who have CHD. It is recommended that further research ought to be carried out by using only one intervention in each trial with a standardised outcome measure, or using factorial designs, so that further cost-effectiveness evaluation of each intervention can be carried out independently, leading to the formulation of a comprehensive, optimised intervention programme for patients with CHD taking antihypertensives.

  • coronary heart disease
  • hypertension
  • cardiology

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  • JH, YCT and PYBL contributed equally.

  • Contributors JH, YCT and PYBL contributed equally as first author. The authors of this research contributed equally to the study design. JH, PYBL and DC contributed equally to formulation of searching strategy. JH, WYN, HYM and WYL contributed equally to eligibility screening of data entries. JH, YCT, PYBL, MFW, WYN and KYL contributed to data extraction from eligible studies and the compilation of them. YCT contributed to data interpretation. JH, YCT, PYBL and MFW wrote the manuscript, and the authors of this research are involved in the revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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