BOLETÍN HTA

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High rates of nonadherence to antihypertensive treatment revealed by high-performance liquid chromatography- tandem mass spectrometry (HP LC-MS/MS) urine analysis. Heart. 2014;100:855–861 7. Ceral J, Habrdova V, Vorisek V, et al. Difficult-to control arterial hypertension or uncooperative patients? The assessment of serum antihypertensive drug levels to differentiate non-responsiveness from non-adherence to recommended therapy. Hypertens Res. 2011;34:87–90 8. Corrao G, Parodi A, Nicotra F, Zambon A, Merlino L, Cesana G, Mancia G. Better compliance to antihypertensive medications reduces cardiovascular risk. J Hypertens 2011;29:610–618. 9. Varleta P, Akel C, Acevedo M, et al. Prevalencia y determinantes de adherencia a terapia antihipertensiva en pacientes de la Region Metropolitanta. Rev Med Chil. 2015;143(5):569-576. 10. Chowdhury R, Khan H, Heydon E, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J. 2013;34:2940–2948. 11. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of arterial hypertension. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal (2018) 39, 3021–3104 12. Wald DS, Law M, Morris JK, et al. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med 2009;122:290–300. 13. MacDonald TM, Williams B, Webb DJ, et al. British Hypertension Society Programme of Prevention And Treatment of Hypertension With Algorithm- based Therapy (PATHWAY). Combination therapy is superior to sequential monotherapy for the initial treatment of hypertension: a double-blind randomized controlled trial. J Am Heart Assoc 2017;6:e006986. 14. Egan BM, Bandyopadhyay D, Shaftman SR, Wagner CS, Zhao Y, Yu-Isenberg KS. Initial monotherapy and combination therapy and hypertension control the first year. 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Relationship between daily dose frequency and adherence to antihypertensive pharmacotherapy: evidence from a meta-analysis. Clin Ther. 2002;24:302-16. 21. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74. 22. Val A, Amorós G, Martínez P, y col.Estudio descriptivo del cumplimiento del tratamiento farmacológico antihipertensivo y validación del test Morisky y Green. Aten Primaria. 1992;10(5):767-770. 23. Whelton PK, Carey RM, Aronow WS et al. et al.2017 Hypertension Guideline Data Supplements-American College of Cardiology. Accedido el 12 enero, 2019, http://jaccjacc.acc.org/Clinical_Document/2017_HBP_FT_DATA_SUPPLEMENT.pdf 24. Kim MT, Hill MN, Lee LR et al. Development and Testing of the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Prog Cardiovasc 2000;15:90-6 25. Fletcher BR, Hartmann-Boyce J, Hinton L et al. The effect of self-monitoring of blood pressure on medication adherence and lifestyle factors: a systematic review and meta-analysis. Am J Hypertens, 2015;28:1209–1221. 26. Bobrow K, Farmer AJ, Springer D, et al. Mobile phone text messages to support treatment adherence in adults with high blood pressure (SMS-Text Adherence Support [StAR]): a single-blind, randomized trial. Circulation. 2016;133(6):592-600. 27. Varleta P, Acevedo M, Akel C et al. Mobile phone text messaging improves antihypertensive drug adherence in the community. J Clin Hypertens, 2017;19:1276-1284. 28. Mazzaglia G, Ambrosioni E, Alacqua M et al. Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation 2009; 120:1598–1605. Referencias No se mencionan explícitamente el uso de recordatorios y educación a través de mensajería de texto que han tenido éxito en algunas comunidades internacionales y nacionales (26,27) . Se insiste en que las intervenciones deben ser integradas y múltiples, puesto que el aplicar sólo una tiene un efecto reducido. Finalmente me parece interesante destacar un comentario de la Guía ESC/ESH que hace referencia a la relevancia de los estudios realizados con hipertensos en el medio clínico usual como sería el nivel de atención primaria, con el propósito de evaluar el impacto de distintas estrategias sobre la adherencia farmacológica. Esto debido a que los tradicionales estudios randomizados controlados, se alejan del control cotidiano real, presentan selección de los pacientes, y tienen otras motivaciones a nivel de los equipos médicos y los pacientes. Dicho en otras palabras, no guardan relación con la atención en el mundo real, por lo cual dificilmente pueden otorgar estrategias en dicho terreno. En esto, tanto los estudios de los grupos italianos, escandinavos y británicos nos han dado lecciones (28) .