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Medication Adherence in Hypertension: A Cluster Randomized Clinical Trial
Saul Blecker1,2, Devin M Mann1,2,3, Tiffany R Martinez1
1Department of Population Health, NYU Grossman School of Medicine, New York, New York.
JAMA Cardiology
|July 9, 2025
Summary
A multicomponent intervention using electronic health records and team care did not improve medication adherence for patients with hypertension. This approach failed to significantly increase the proportion of days covered (PDC) or improve blood pressure control.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Clinical Pharmacy
Background:
- Medication nonadherence affects nearly half of hypertension patients and is often underrecognized.
- Electronic health record (EHR)-pharmacy data linkages offer scalable solutions for assessing adherence.
- Identifying and addressing adherence barriers is crucial for managing uncontrolled hypertension.
Purpose of the Study:
- To evaluate a multicomponent intervention for uncontrolled hypertension and medication nonadherence.
- The intervention integrated EHR-pharmacy data with team-based care to address adherence barriers.
- To determine if this intervention improves medication adherence and blood pressure control.
Main Methods:
- A pragmatic, 2-arm cluster randomized trial (TEAMLET) involving 10 primary care sites.
- Included adults with uncontrolled hypertension and low medication adherence (proportion of days covered [PDC] <80%).
- Intervention group received automated identification of nonadherence, barrier screening, clinical decision support, and adherence discussions; control received usual care.
Main Results:
- 1726 patients were included; mean baseline PDC was 33.2%.
- No significant difference in the change of PDC from baseline to 12 months between groups (intervention: 18.5% vs. control: 18.2%).
- No significant differences observed in blood pressure changes or the proportion of patients achieving ≥80% PDC.
Conclusions:
- The TEAMLET intervention, combining EHR technology and team care, did not improve antihypertensive medication adherence.
- Automated identification and team-based care strategies did not lead to significant improvements in adherence or blood pressure.
- Further research is needed to identify effective strategies for improving medication adherence in hypertension management.
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