Rational Pharmacotherapy in Cardiology

Advanced search

Adherence to Antihypertensive Therapy: A Systematic Review of Russian Prospective Studies from 2000 to 2019

Full Text:


Russia belongs to countries with a high prevalence of arterial hypertension (AH), which is the main cause of premature death in the Russian population. The level of blood pressure (BP) is controlled in less than a third of patients, which may be due to poor adherence to medical recommendations and irregular medication. The manuscript provides a review of studies evaluating the effectiveness of measures to improve adherence to antihypertensive therapy (AHT).

Aim. To prepare a systematic review of Russian studies to assess the effectiveness of measures to increase adherence to AHT, to determine/describe the main directions of the intervention and the methodological level.

Material and methods. The search for full-text articles on adherence to AHT published in Russian in the period from 2000 to 2019 was carried out in the main Russian and international electronic databases, Embase, Russian Medicine, MEDLINE. Of the 563 publications found, 20 were included in the review.

Results. In 14 studies, adherence was assessed using the 4-item Morisky Medication Adherence Scale (MMAS-4), other studies used bespoke questionnaires or pill counts. Two studies examined factors associated with adherence. The observation period was up 6 weeks to 12 months, the number of participants is 30-2435 people. A higher adherence was noted in women, people over 50 years old, with higher education, working, with concomitant diabetes mellitus and a history of myocardial infarction. Patient education was effective interventions to improve adherence (in particular, in studies, improvement on the MMAS-4 from 1.8 to 3.9 points, p=0.0002 or from 2.80 to 3.79 points, p<0.0001), telephone reminders (p<0.0001), training in self-measurement of blood pressure (p<0.05) and fixed combinations of drugs (p<0.05).

Conclusion. The most effective ways to improve adherence are patient education and the use of drugs fixed combinations. In most studies, subjective methods of adherence assessing were used.

About the Authors

E. V. Bochkareva
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Elena V. Bochkareva – MD, PhD, Head of Laboratory of Drug Prevention in the Primary Care, Department of Primary Prevention of Chronic Non-Communicable Diseases in the Healthcare System

Petroverigsky per. 10, Moscow, 101990

E. K. Butina
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Ekaterina K. Butina – MD, PhD, Senior Researcher, Laboratory of Drug Prevention in the Primary Care, Department of Primary Prevention of Chronic Non-Communicable Diseases in the Healthcare System

Petroverigsky per. 10, Moscow, 101990

I. V. Kim
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Irina V. Kim – MD, PhD, Researcher, Laboratory of Drug Prevention in the Primary Care, Department of Primary Prevention of Chronic Non-Communicable Diseases in the Healthcare System

Petroverigsky per. 10, Moscow, 101990

A. V. Kontsevaya
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Anna V. Kontsevaya – MD, PhD, Deputy Director for Scientific and Analytical Work

Petroverigsky per. 10, Moscow, 101990

O. M. Drapkina
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Oxana M. Drapkina – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director

Petroverigsky per. 10, Moscow, 101990


1. Balanova Yu.A., Kontsevaya A.V., Shalnova S.A., et al. Life quality of persons with arterial hypertension in Russia – is there relation to treatment? (by data from populational study ESSE-RF). Russ J Cardiol. 2016;9(137):7-13 (In Russ.) DOI:10.15829/1560-4071-2016-9-7-13.

2. Burnier M. Managing ‘resistance’: is adherence a target for treatment? Curr Opin Nephrol Hypertens. 2014;23:439-43. DOI:10.1097/MNH.0000000000000045.

3. Vrijens B., Vincze G., Kristanto P., et al. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ. 2008;336:1114-7. DOI:10.1136/bmj.39553.670231.25.

4. Kolandaivelu K., Leiden B.B., O’Gara P.T., Bhatt D.L. Non-adherence to cardiovascular medications. Eur Heart J. 2014;35:3267-76. DOI:10.1093/eurheartj/ehu364.

5. Chowdhury R., Khan H., Heydon E., et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J. 2013;34:2940-8. DOI:10.1093/eurheartj/eht295.

6. Liberati A., Altman D.G., Tetzlaff J., et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62:e1-34. DOI:10.1016/j.jclinepi.2009.06.006.

7. Sviryaev Y.V., Zvartau N.E., Rotari O.P., et al. New perspectives of improving of compliance - results of open study of adherence of patients to treatment with fixed in one blister combinations of enalapril and indapamide. Arterial Hypertension. 2006;12(3):262-7 (In Russ.)

8. Kotovskaya Yu. V., Villevalde S.V., Tigai Zh.G., Kobalava Zh.D., on behalf of physicians participating in the CONSTANTA program. Hypertensive patients' adherence, motivation, and awareness during fixeddose perindopril A and amlodipine combination treatment (results of the CONSTANTA trial). Ter Arkhiv. 2015;87(2):64-9. DOI:10.17116/terarkh201587264-69 (In Russ.)

9. Kobalava Z.D., Villevalde S.V., Isikova K.V. Impact of educational programs and rational use of perindopril on motivation and adherence in arterial hypertension. Results of the PRISMA study. Clin Pharmacol Ther. 2011;20(4):15-21 (In Russ.)

10. Kobalava Z.D., Villevalde S.V., Isikova K.V. Elevation of compliance and motivation to antihypertensive therapy in patients with arterial hypertension through educational programs and rational use of angiotensin converting enzyme perindopril. Results of the PRISMA study. Consilium Medicum. 2011;5:15-22 (In Russ.)

11. Glezer M.G., Deev A.D., on behalf of the participants of the program FORSAZH. How to increase the effectiveness of antihypertensive therapy in clinical practice: results of the Russian observational program FORSAZH. Kardiologiia. 2016;1:18-24 (In Russ.) DOI:10.18565/cardio.2016.1.13-24.

12. Kagramanyan I.N. The role of compliance in improving quality of medical care. Remedium. 2015;5:25-9 (In Russ.)

13. Kaskaeva D.S., Petrova M.M., Krylova E.J., et al. Assessment of compliance hypertensive patients at 6 months follow-up, dynamic railway workers. International Journal of Applied and Fundamental Research. 2015;4:50-2 (In Russ.)

14. Ushakova S.E., Kontsevaya A.V., Knyazhevskaya O.V., et al. Therapeutic education and treatment compliance in hypertensive patients. Cardiovascular Therapy and Prevention. 2005;4(1):32-5 (In Russ.)

15. Chazova I.E., Ageev F.T., Fofanova T.V., et al. Education and self-education of the patients is an important step towards increasing patients acceptance of therapy. Systemic Hypertension. 2014;3:7- 10 (In Russ.)

16. Ageev F.T., Drobizhev M.B., Smirnova M.D., et al. Free or fixed combination of enalapril and hypothiazide in real ambulatory practice: what is better for a patient with arterial hypertension? Kardiologiia. 2008;5:10-5 (In Russ.)

17. Fofanova T.V., Plisyuk A.G., Smirnova M.D., et al. Evaluation of treatment effectiveness and adherence to therapy of the combined Enziks preparation and a free combination of enalapril and indapamide in patients with arterial hypertension in the outpatient setting. Serdtse. 2008;5(7):298-302 (In Russ.)

18. Karpov Yu.A., on behalf of the FORTISSIMO program participants. The FORTISSIMO program: advantages of fixed full dose combination of perindopril arginine and Indapamide in the treatment of poorly controlled arterial hypertension. Kardiologiia. 2013;3:37-43 (In Russ.)

19. Glezer M.G., on behalf of the OPTIMUM program participants. Evaluation of antihypertensive efficacy and patient adherence to treatment with the new formulation Perindopril arginine (orally disintegrating tablet) in general clinical practice: OPTIMUM Program. Kardiologiia. 2016;56(4):36-41 (In Russ.) DOI:10.18565/cardio.2016.4.36-41.

20. Glezer M.G., on behalf of program participants. The use of fixed Perindopril A/Amlodipine combination provides high compliance to therapy, effective and safe arterial pressure lowering in patients with previous ineffective therapy. The POTENTIAL Program. Kardiologiia. 2015;12:17-24 (In Russ.)

21. Vologdina I., Poroshina E., Rozov A., Simonova O. Combined therapy in old patients with coronary heart disease and arterial hypertension. Vrach. 2009;4:32-6 (In Russ.)

22. Panov A.V., Alugishvili M.Z., Abesadze I.T., et al. The antihypertensive effect of the fixed combination of Lisinopril and amlodipine in patients with coronary heart disease after coronary artery bypass grafting. Kardiologiia. 2015;6:27-33 (In Russ)

23. Sarycheva A.A., Nebieridze D.V., Kamyshova T.V. Is it possible to improve the adherence to treatment of hypertension and dyslipidemia in patients without clinical manifestations of atherosclerosis? Rational Pharmacotherapy in Cardiology. 2017;13(5):602-8 (In Russ.) DOI:10.20996/1819-6446-2017-13-5-602-608.

24. Smirnova M.D., Cygareishvili E.V., Ageev F.T., et al. The availability of a home tonometer as a factor that increases therapy compliance in outpatients with arterial hypertension. Systemic Hypertension. 2012;4:44-9 (In Russ.)

25. Oschepkova E.V., Cagareishvili E.V., Rogoza A.N. Self-monitoring of blood pressure by patients increases adherence to the treatment of arterial hypertension (1 year observation). Systemic Hypertension. 2004;2:32-7 (In Russ.)

26. Chesnokova I.V. Achieving target values of arterial pressure in hypertensive disease through fixed combination of amlodipine and perinopril arginine. International Research Journal 2019;1(79):138- 14 (In Russ.) DOI:10.23670/IRJ.2019.79.1.027.

27. Tsioufisa K., Kreutzb R., Sykara G., et al. Impact of single-pill combination therapy on adherence, blood pressure control, and clinical outcomes: a rapid evidence assessment of recent literature. J Hypertens. 38:1016-28. DOI:10.1097/HJH.0000000000002381.

28. Nguyen T.M., Caze A.L., Cottrellet N. What are validated self-report adherence scales really measuring?: a systematic review. Br J Clin Pharmacol. 2014;77:427-45. DOI:10.1111/bcp.12194.

29. El Alili M., Vrijens B., Demonceau J., et al. A scoping review of studies comparing the medication event monitoring system [MEMS] with alternative methods for measuring medicationadherence. Br J Clin Pharmacol. 2016;82:268-79. DOI:10.1111/bcp.12942.

30. Forbes C.A., Deshpande S., Sorio-Vilela F., et al. A systematic literature review comparing methods for the measurement of patient persistence and adherence. Curr Med Res Opin. 2018;34(9):1613- 25. DOI:10.1080/03007995.2018.1477747.

31. Despres F., Perreault S., Lalonde L., et al. Impact of drug plans on adherence to and the cost of antihypertensive medications among patients covered by a universal drug insurance program. Can J Cardiol. 2014;30(5):560-7. DOI:10.1016/j.cjca.2013.11.032.

32. Corrao G., Zambon A., Parodi A., et al. Discontinuation of and changes in drug therapy for hypertension among newly-treated patients: a population-based study in Italy. J Hypertens. 2008;26:819- 24. DOI:10.1097/HJH.0b013e3282f4edd7.

33. Tomaszewski M., White C., Patel P., et al. High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) urine analysis. Heart. 2014;100(11):855-61. DOI:10.1136/heartjnl-2013-305063.

34. Nieuwlaat R., Wilczynski N., Navarro T., et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014;11:CD000011. DOI:10.1002/14651858.CD000011.pub4.

35. Ascertaining Barriers for Compliance: policies for safe, effective and cost effective use of medicines in Europe. Final Report of the ABC project. June 2012 [cited by Jun 01, 2020]. Available from:

36. De Geest S., Zullig L.L., Dunbar-Jacob J., et al. ESPACOMP medication adherence reporting guideline (EMERGE). Ann Intern Med. 2018;169(1):30-5. DOI:10.7326/M18-0543.

37. Conn V.S., Ruppar T.M., Chase J.D., et al. Interventions to improve medication adherence in hypertensive patients: systematic review and meta-analysis. Curr Hypertens Rep. 2015;17(12):94. DOI:10.1007/s11906-015-0606-5.

38. Conn V.S., Ruppar T.M. Medication adherence outcomes of 771 intervention trials: systematic review and meta-analysis. Prev Med. 2017;99:269-76. DOI:10.1016/j.ypmed.2017.03.008.

39. Xu R., Xiea X., Lia S., et al. Interventions to improve medication adherence among Chinese patients with hypertension: a systematic review and meta-analysis of randomized controlled trails. Int J Pharm Pract. 2018;26(4):291-301. DOI:10.1111/ijpp.12452.

For citation:

Bochkareva E.V., Butina E.K., Kim I.V., Kontsevaya A.V., Drapkina O.M. Adherence to Antihypertensive Therapy: A Systematic Review of Russian Prospective Studies from 2000 to 2019 Rational Pharmacotherapy in Cardiology. 2020;16(5):770-779. (In Russ.)

Views: 56

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)