Randomized Pilot Study of a Behavioral Feedback Intervention to Improve Medication Adherence in Older Adults With Hypertension

Background and Objectives: Older adults' adherence to antihypertensive medications is far lower than what is considered necessary for clinical effectiveness, despite the risks for adverse cardiovascular events from uncontrolled blood pressure (BP) in the elderly. This pilot study tested a novel 8-week behavioral feedback intervention to improve antihypertensive medication adherence (MA) and BP control among older adults on existing treatment for hypertension. Methods: Adults 60 years old, or older taking at least 1 antihypertensive medication were randomized to receive the nurse-delivered adherence intervention or usual care. Medication adherence was monitored continuously using electronic monitoring for 20 weeks. Intervention-group participants received biweekly MA and BP feedback, habit counseling, medication and disease education, a medication instruction card, and were given an electronic medication bottle cap with a digital display that provided daily adherence feedback during the 8-week intervention. Blood pressure was measured by a nurse at 12 and 20 weeks after randomization. Adherence and BP outcomes were described using descriptive statistics and analyzed for between-and within-group differences using Mann-Whitney U tests. Results: Fifteen participants (median age, 71 years; 73% female) were eligible for randomization. Participants took an average of 5.8 prescription medications and 2.93 over-the-counter medications per day. A nonsignificant difference was noted in baseline MA between groups. At the end of the intervention, the treatment group had better antihypertensive MA than did the control group (median MA: 100% vs 27.3%, U = 5.00, P = .013). Systolic BP improved slightly in the intervention group during the study and was significantly different at week 12 (median systolic BP: 130 vs 152 mm Hg; U = 4.50, P = .008). Diastolic BP was largely unchanged over the course of the study. Conclusion: The results indicate that the intervention had a positive effect on MA. Additional testing is needed to further evaluate the intervention and its effect on adherence behavior and BP control.