Adherence to antihypertensive drug treatment in Brazil: a systematic review and meta-analysis

Coelho, Juliana Chaves; Guimarães, Mayra Cristina da Luz Pádua; Vaz, Ana Katly Martins Gualberto; Meira, Karina Cardoso; Santos, Juliano dos; Lee, Renata Jae Won; Drager, Luciano Ferreira; Pierin, Angela Maria Geraldo

doi:10.1590/1413-81232024298.19282022EN

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ARTICLES REVIEWS • Ciênc. saúde coletiva 29 (08) • Aug 2024 • https://doi.org/10.1590/1413-81232024298.19282022EN copy

Adherence to antihypertensive drug treatment in Brazil: a systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to evaluate the adherence to antihypertensive treatment prevalence in the Brazilian population based on peer-reviewed studies which used instruments exclusively designed and/or adapted for this purpose. A systematic review with meta-analysis based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was carried out in the BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, and MEDLINE databases, as well as the AgeLine, Google Scholar and ScienceDirect academic search engines. The protocol was registered with PROSPERO (CRD42021292689). Random effects models were used for a meta-analysis of the prevalence obtained from individual studies. A total of 104 studies were included in the meta-analysis on antihypertensive treatment in the Brazilian population, totaling 38,299 patients. The most used instrument was the four-item Morisky-Green Test (49.5%). The adherence prevalence estimated by the meta-analysis was 44.4% (95%CI: 39.12%-49.94%, I₂ = 91.17, p < 0.001), showing high heterogeneity. The adherence to antihypertensive treatment prevalence found in national studies was unsatisfactory, demonstrating that this problem continues to be a major challenge.

Key words:
Hypertension; Medication adherence; Evaluation of research programs and instruments; Prevalence; Meta-analysis

Authors	Year of publication	Journal	Study type	Sample size	Adhesion evaluation method	Risk of bias of the study*
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5. Medeiros ACD et al.	2009	Lat Am J Pharm	Cross-sectional	450	Four-item Morisky-Green Test	7
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7. Santa-Helena ET et al.	2010	Cad Saude Publica	Cross-sectional	595	Medication Adherence Questionnaire - Qualaids (MAQ-Q)	9
8. Santos BRM et al.	2010	Braz J Pharm Sci	Cross-sectional	102	Four-item Morisky-Green Test	7
9. Ungari AQ et al.	2010	Braz J Pharm Sci	Cross-sectional	109	Four-item Morisky-Green Test	9
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11. Helena ETS et al.	2010	Saúde Soc	Cross-sectional	595	Medication Adherence Questionnaire - Qualaids (MAQ-Q)	10
12. Obreli-Neto PR et al.	2011	Int J Clin Pharm	Clinical trial	194	Four-item Morisky-Green Test	7
13. Cavalari E et al.	2012	Rev. Enferm. UERJ	Cross-sectional	75	Four-item Morisky-Green Test	7
14. Demoner MS et al.	2012	Acta Paul Enferm	Cross-sectional	150	Four-item Morisky-Green Test	7
15. Aguiar PM et al.	2012	J Am Pharm Assoc	Controlled trial (experimental without randomization)	35	Four-item Morisky-Green Test	6
16. Oliveira-Filho AD et al.	2012	Arq Bras Cardiol	Cross-sectional	223	Morisky eight-item Medication Adherence Scale (MMAS-8)	8
17. Bastos-Barbosa RG et al.	2012	Arq Bras Cardiol	Cross-sectional	60	Four-item Morisky-Green Test	4 - excluded from meta-analysis
18. Massierer D et al.	2012	Arq Bras Cardiol	Cross-sectional	106	Four-item Morisky-Green Test	7
19. Pucci N et al.	2012	Arq Bras Cardiol	Cross-sectional	260	Four-item Morisky-Green Test	6
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21. Eid LP et al.	2013	Rev Eletrônica Enferm	Cross-sectional	90	Four-item Morisky-Green Test	7
22. Silva CS et al.	2013	Rev Esc Enferm USP	Cross-sectional	340	Primary Care Assessment Tool (PCAT)	8
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24. Nascimento ACG et al.	2013	Rev APS	Cross-sectional	72	Martín-Bayarre-Grade (MBG)	8
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26. Oliveira DC et al.	2013	Rev Soc Bra Clín Méd	Cross-sectional	850	Four-item Morisky-Green Test	8
27. Grezzana GB et al.	2013	Arq Bras Cardiol	Cross-sectional	143	Four-item Morisky-Green Test	6
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31. Raymundo ACN et al.	2014	Rev Esc Enferm USP	Controlled trial (experimental without randomization)	283	Four-item Morisky-Green Test	8
32. Martins AG et al.	2014	Acta Paul Enferm	Cross-sectional	140	Four-item Morisky-Green Test	7
33. Silva LFRS et al.	2014	Rev Ciênc Farm Básica Apl	Cross-sectional	117	Four-item Morisky-Green Test	5
34. Souza CS et al.	2014	Arq Bras Cardiol	Cross-sectional	353	Four-item Morisky-Green Test	8
35. Martins BCC et al.	2014	Rev Bras Hipertens	Uncontrolled trial (quasi-experimental)	23	Four-item Morisky-Green Test	6
36. Vieira LB et al.	2014	Rev Bras Cardiol	Cross-sectional	32	Four-item Morisky-Green Test	6
37. Weber D et al.	2014	Rev Bras Hipertens	Retrospective cohort	100	Four-item Morisky-Green Test	8
38. Dias TK et al.	2014	Geriatr, Gerontol Aging	Cross-sectional	504	Four-item Morisky-Green Test	9
39. Medeiros ARC et al.	2014	Saúde Debate	Cross-sectional	118	Medeiros Test	6
40. Barreto MS et al.	2015	Rev Bras Enferm	Cross-sectional	422	Medication Adherence Questionnaire - Qualaids (MAQ-Q)	10
41. Magnabosco P et al.	2015	Rev Latino-Am Enfermagem	Cross-sectional	247	Medication Adherence Questionnaire - Qualaids (MAQ-Q)	9
42. Mantovani MF et al.	2015	Rev enferm UFPE on line	Cross-sectional	100	Brief Medication Questionaire (BMQ)	7
43. Nunes MGS et al.	2015	Acta Paul Enferm	Cross-sectional	458	Four-item Morisky-Green Test	8
44. Ribeiro IJS et al.	2015	Revista Baiana Enferm	Cross-sectional	92	Four-item Morisky-Green Test	7
45. Vancini-Campanharo CR et al.	2015	Rev Latino-Am Enfermagem	Cross-sectional	116	Four-item Morisky-Green Test	8
46. Rigoni CC et al.	2015	Braz J Pharm Sci	Uncontrolled trial (quasi-experimental)	40	Four-item Morisky-Green Test	7
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58. Corrêa NB et al.	2016	J Am Soc Hypertens	Prospective cohort	21	Morisky eight-item Medication Adherence Scale (MMAS-8)	6
59. Jesus NS et al.	2016	Arq Bras Cardiol	Cross-sectional	96	Four-item Morisky-Green Test	8
60. Mansour SN et al.	2016	Epidemiol Serv Saúde	Cross-sectional	106	Treatment Adherence Measure (TAM)	6
61. Machado ALG et al.	2017	Rev Enferm UFPE on line	Cross-sectional	145	SAH Treatment Adherence Questionnaire (SAHTAQ)	6
62. Maciel APF et al.	2017	Rev Enferm UFPE on line	Controlled trial (experimental without randomization)	720	Four-item Morisky-Green Test	7
63. Fritzen JS et al.	2017	Rev Saúde Pública	Cross-sectional	414	Brief Medication Questionaire (BMQ)	7
64. Righi CG et al.	2017	J Clin Hypertens (Greenwich).	Cross-sectional	416	Morisky eight-item Medication Adherence Scale (MMAS-8)	8
65. Aquino GA et al.	2017	Rev Bras Geriatr Gerontol	Cross-sectional	279	Four-item Morisky-Green Test	8
66. Pereira MG et al.	2017	Rev Baiana Saúde Pública	Cross-sectional	60	Four-item Morisky-Green Test	6
67. Rocha ML et al.	2017	Rev APS	Cross-sectional	405	Borges	9
68. Klafkea A et al.	2017	Rev Bras Med Fam Comunidade	Cross-sectional	128	Borges	9
69. Albuquerque NLS et al.	2018	Rev Bras Enferm	Cross-sectional	270	Four-item Morisky-Green Test	5
70. Feriato KT et al.	2018	Rev Bras Enferm	Cross-sectional	108	Four-item Morisky-Green Test	9
71. Ghelman LG et al.	2018	Rev Enferm UFPE on line	Cross-sectional	60	Four-item Morisky-Green Test	6
72. Sousa ASJ et al.	2018	Rev Enferm UERJ	Cross-sectional	602	Four-item Morisky-Green Test	8
73. Gewehr DM et al.	2018	Saúde Debate	Cross-sectional	145	Brief Medication Questionaire (BMQ)	8
74. Falcão AS et al.	2018	Rev Bras Promoc Saúde	Cross-sectional	254	SAH Treatment Adherence Questionnaire (SAHTAQ)	6
75. Dallacosta FM et al.	2019	Rev Pesqui Cuid Fundam (Online)	Cross-sectional	72	Brief Medication Questionaire (BMQ)	8
76. Santana BS et al.	2019	Esc Anna Nery	Cross-sectional	133	Four-item Morisky-Green Test	5
77. Birck MG et al.	2019	Sao Paulo Med J	Prospective cohort	15.105	Four-item Morisky-Green Test	8
78. Almeida ALJ et al.	2019	Rev APS	Cross-sectional	114	Treatment Adherence Measure (TAM)	9
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80. Santos LMC et al.	2019	Rev Psicol Saúde	Cross-sectional	100	Morisky eight-item Medication Adherence Scale (MMAS-8)	7
81. Amaral MMB et al.	2019	Rev Salud Pública	Controlled trial (experimental without randomization)	14	SAH Treatment Adherence Questionnaire (SAHTAQ)	7
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85. Nascimento MO et al.	2020	Texto Contexto Enferm	Cross-sectional	421	Morisky eight-item Medication Adherence Scale (MMAS-8)	8
86. Silva LM et al.	2020	Rev Esc Enferm USP	Cross-sectional	193	Four-item Morisky-Green Test	8
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106. Wachholz PA et al.	2016	Acta Sci, Health Sci	Prospective cohort	213	Treatment Adherence Measure (TAM)	8

Variables	n	Prevalence (%)	95%CI (%)	I2 (%)	p-value*
Decade
2001-2010	10	42.09	28.76-56.69	94.90	0.74
2011-2021	94	44.73	39.01-50.60	98.10	0.74
Region
Center-West	5	26.86	17.26-39.27	89.2	0.001
Multicenter	2	21.86	21.21-22.52	79.5
Northeast	35	43.88	35.19-52.96	97.1
Southeast	40	42.07	33.90-50.69	95
South	22	55.77	43.11-67.73	96.3

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Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva