Antihypertensive medication nonadherence is significant contributor to poor BP control. Patient-related factors (lack of motivation or risk understanding) are important. The aim of PRISMA study was to determine the impact of integrated approach with therapy based on perindopril arginine in the improvement of motivation, adherence to antihypertensive treatment and BP control.Design and Method:
906 (315 male, 56.0 ± 10.6 years) non-adherent (score < 4 in Morisky and Green Test for Measure of Adherence to Therapy) hypertensive patients with planning or action stages of behavior changes (Prochaska and DiClemente model) with uncontrolled hypertension (BP > 140/90 mmHg) were randomly assigned to 2 strategies: integrated approach with therapy based on perindopril arginine with added-on therapy if necessary (G1, n = 755) or routine practice (G2, n = 151). Educational programs for patients and physicians, individualized risk assessment, adoption of lifestyle changes, frequent follow-up visits with questionnaires and discussion, phone reminding, regular home BP measurements were performed. Patients were provided with food and physical activity pyramid cards, diary for recording home BP. 7 visits were scheduled during 12-month period. Wilcoxon test, χ2 analysis were performed. P < 0.05 was considered statistically significant.Results:
At the end of study more prominent antihypertensive effect was seen in G1 comparing G2: achieved BP <140/90 mmHg in 87.2 vs 68.5% patients, χ;2 = 3.0, p < 0.05; absolute BP decrease (159 ± 15/95 ± 9 vs 127 ± 11/79 ± 7 mmHg in G1 and 161 ± 14/95 ± 9 vs 133 ± 12/81 ± 8 mmHg in G2 (p < 0.05 for each)). In G1 comparing with G2 more patients became adherent (71.7 vs 52.2%, χ;2 = 25.8, p < 0.001); more patients with planning or action stages of behavior changes increased motivation to maintenance stage (71.1 vs 43.5%, χ;2 = 47.5, p < 0.001), relapses of behavior changes into pre-contemplation/ contemplation stages were more rare (3.8 vs 8.6%, χ;2 = 10.2, p < 0.001).Conclusions:
Complex patient approach strategy including educational programs, reminding tips and state-of-art therapy may significantly increase adherence to antihypertensive treatment and improve BP control in everyday routine practice.