Efficacy of telephone and mail intervention in patient compliance with antihypertensive drugs in hypertension.: ETECUM-HTA study

Objective. To study the efficacy of telephone and mail intervention in therapeutic compliance among patients with mild to moderate hypertension. Design. A prospective controlled multicenter clinical trial. Setting. Eighty-five primary care centers in Spain, with a duration of 6 months. Patients. A total of 636 patients with newly diagnosed or uncontrolled hypertension were included. Interventions. The patients were randomized and distributed between the following groups: (i) control (CG)-under routine clinical management; (ii) mail intervention (MIG)-received a mailed message reinforcing compliance and reminding of the visits (15 days, 2 and 4 months); (iii) telephone intervention (TIG)-received a telephone call at 15 days, then at 7 and 15 weeks. Main outcome measure. Five visits were scheduled, with the measurement of blood pressure and counting of tablets. Compliers were defined as subjects showing 80-110% drug consumption. Calculations were made of mean percentage compliance (MPC) and compliers, mean blood pressure and percentage controlled subjects. Results. Five hundred and thirty-eight patients completed the study (261 males); 85.5% were compliers (CI=82.5-88.5; n=460). The MPC was 95.1 +/- 19.6% (CI=93.28-96.92). The CG consisted of 182 individuals, MIG=172 and TIG=184. Compliers represented 69.2% of the CG (CI 62.5-75.9%), 91.3% (CI=87.1-95.5) of the MIG (p=0.0001) and 96.2% of the TIG (CI 93.5-98.9%); the final MPC was 89.6%+/- 15 in CG, 96.6%+/- 12 in MIG and 99.1 +/- 26.8 in TIG (p=0.0001). The percentage of controlled subjects was 47.2% in CG (CI=40-54.4), 61.3% in MIG (CI=54.1-68.5%) and 63.3% in TIG (CI=56.4-70.2%) (p<0.05). Conclusions. TIG and MIG are effective measures for improving patient compliance in hypertension.