CARE INTENSIFICATION TO IMPROVE ADHERENCE TO HYPERTENSIVE MEDICATION TREATMENT IN PRIMARY CARE: A RANDOMIZED CONTROLLED TRIAL

Background: Non-adherence to hypertensive medications is a prevalent problem in Brazilian primary care and it is a major barrier to reduce morbidity and mortality. We aim to evaluate the effectiveness of a psychosocial intervention in adherence improvement to hypertensive medication. Methods: A total of 234 voluntaries with hypertension for at least six months were recruited from ten Family Health Strategy (FHS) teams in Blumenau/Brazil. They were randomized in a 1:1 ratio for the intervention (IG) and control group (CG). The IG participated in a psychosocial intervention approach entailing six dialogical meetings focused on medication intake scenes. CG received usual care only. Adherence (estimated by validated questionnaires) and systolic and diastolic blood pressure (SBP and DBP) were measured in different points of the intervention and after its closure. The data was analyzed by intention to treatment. Results: Comparison between IG and CG reveled statistically differences in adherence measures (IG 65.7% vs CG 40.4%, p=0.005), blood pressure levels (SBP IG 124.77, SD 13.33 vs CG 136.0, SD 23.01, p=0.05 and DPB IG 76.77, SD 8.73 vs CG 83.63, SD 11.58, p=0.025) and behavioral change to better adherence status at post intervention monitoring (IG 37.1% vs CG 15.4%, p=0.029). The CG in-group analyses showed no statistically difference in adherence levels, adherence behavioral change and blood pressure control. Conclusion: The intervention increased adherence to hypertensive medication treatment and promoted better blood pressure control. Furthermore, the intervention proved sufficiently to impact in the adherence levels at complex real daily life of primary care services.