Algorithmic Identification Intervention Increased Adherence to BP Medications in Patients With Hypertension

Research published in JAMA Network Open demonstrates a cost-neutral intervention method to increase adherence to blood pressure (BP) medications in patients who are being treated for diabetes, hypertension, or lipid disorders. These findings, according to the authors, suggest that algorithmic identification of medication nonadherence in the primary care setting along with support from clinicians and pharmacist outreach is possible in the improvement of adherence for certain cardiometabolic medications.¹

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Suboptimal medication adherence is common in adults who are being treated for hypertension, type 2 diabetes, or dyslipidemia, according to the authors. Low medication adherence is widely recognized as a major barrier to better clinical outcomes in individuals with cardiometabolic conditions; however, it is difficult for health care professionals to accurately identify low medication adherence because patients may not disclose accurate adherence information. The authors hypothesized that an intervention specifically designed to identify and address medication nonadherence may improve both adherence and control of patients’ hypertension, diabetes, and dyslipidemia.¹

For this 2-arm, patient-randomized, parallel group study (NCT03748420), the investigators examined the effectiveness of an algorithmic identification intervention method to determine low medication adherence, clinical decision support to health care professionals, as well as pharmacist outreach to patients to improve their cardiometabolic medication adherence, BP, low-density lipoprotein cholesterol (LDL-C), and hemoglobin A1c (HbA1c). The investigators enrolled 5421 participants across 26 primary care clinics. The study was conducted from August 19, 2020, to September 30, 2023, and data analysis was performed from October 1, 2023, to August 30, 2024.^1,2

On the date of an index visit, participants had met the following criteria: be aged 18 to 75 years; received a statin or not at the goal level for HbA1c or BP; and had a proportion of days covered less than 80% for 1 or more BP or noninsulin glucose-lowering medications or a statin. Electronic health record-linked clinical decision support identified and encouraged discussion of medication adherence issues, and for those in the intervention cohort who continued to meet the eligibility criteria 6 months following an index visit, pharmacist telephone outreach was attempted.^1,2

Each cohort—hypertension, diabetes, and dyslipidemia—had their own primary end points. The end points for the hypertension group included the following: achievement of proportion of days covered greater than or equal to 80% for at least 1 antihypertensive medication in each currently active BP medication class 12 months after the index date, and the change from the last recorded systolic BP (SBP) at the index encounter to the last recorded SBP at the encounter closest to the date 12 months after the index date.^1,2

Twelve months after the index date, intervention patients were observed to have better adherence to BP medications (adjusted odds ratio [AOR], 1.29; 95% CI, 1.06-1.56); however, there was no better adherence to statins (AOR, 1.18; 95% CI, 0.99-1.41) or noninsulin diabetes medications (AOR, 1.03; 95% CI, 0.82-1.30) that were observed when compared with patients receiving usual care. Additionally, the intervention method did not improve mean HbA1c (−0.2%; 95% CI, −0.4 to 0.1), systolic BP (1.4 mm Hg; 95% CI, −0.8 to 3.5 mm Hg), or LDL-C (−1.8 mg/dL; 95% CI, −6.5 to 2.8 mg/dL).¹

Further, intervention patients who were eligible for pharmacist outreach had improved HbA1c (−0.4%; 95% CI,−0.8% to −0.1%) compared with those not eligible for outreach (−0.0; 95% CI,−0.3% to 0.3%). The investigators did not observe a significant difference in health care use costs between the 2 study groups.¹

One of the most significant limitations, according to the authors, was the pharmacist outreach component. Because this intervention was completed in less than half of patients who were eligible for outreach, more research may be necessary to confirm these findings. In addition, the trial can be replicated to include other care settings and different groups of patients, particularly those who are not insured or considered underserved.¹

REFERENCES

1. O’Connor PJ, Haapala JL, Dehmer SP, et al. Clinical Decision Support and Cardiometabolic Medication Adherence: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(1):e2453745. doi:10.1001/jamanetworkopen.2024.53745

2. Medication Adherence Clinical Decision Support (ADH-Wizard). ClinicalTrials.gov identifier: NCT03748420. Updated February 26, 2024. Accessed March 7, 2025. https://clinicaltrials.gov/study/NCT03748420