The purpose of this study is to test an intervention to help older adults do a better job of
following blood pressure medication regimens prescribed by their health care providers.
Hypertension is present in 26.7% of the U.S. adult population between ages 20 to 74
(National Center for Health Statistics, 2006). The prevalence increases with age.
Sixty-seven percent of adults aged 60 years or older have hypertension, a rise from 58% just
ten years earlier (Ostchega, Dillon, Hughes, Carroll, & Yoon, 2007). Uncontrolled
hypertension increases the risk for heart attack, stroke, congestive heart failure, and
kidney disease (Chobanian et al., 2003; Stamler, Stamler, & Neaton, 1993; Vasan et al.,
2001). Maintaining a normal blood pressure has been shown to be associated with a greater
probability of living to age 85, and of living to age 85 without major health concerns
(Terry et al., 2005). The most common treatment for managing hypertension involves the use
of antihypertensive medications. These medications have been shown to effectively lower
blood pressure (BP) and prevent the development of serious sequelae (Chobanian et al.,
2003). Unfortunately, failure to adhere to antihypertensive medication regimens can impede
the effectiveness of therapy.
Studies have reported levels of medication adherence among the elderly ranging from 26% to
59% (Botelho & Dudrak, 1992; van Eijken, Tsang, Wensing, de Smet, & Grol, 2003). Adherence
to a medication regimen requires a set of behaviors that include obtaining the medication;
timely administration of the correct drug, dose, and route; and persisting with taking the
medication as long as the medication is needed. Success at these behaviors can be hampered
by many of the changes often seen with age. Sensory loss, disturbances in memory and
cognition, depression, and lifestyle changes such as retirement can disrupt routines or
affect skills previously used to maintain medication adherence (Brown et al., 2005; Conn,
Taylor, & Miller, 1994; Coons et al., 1994; Gehi, Haas, Pipkin, & Whooley, 2005; Schlenk,
Dunbar-Jacob, & Engberg, 2004; Vik, Maxwell, & Hogan, 2004). Effective community-based
interventions are needed to equip health care providers with tools to improve
antihypertensive medication regimen adherence among their older patients. Many interventions
have been tested to improve medication adherence in hypertension, but few addressing the
unique needs of older adults. Of those that have been tested, there has been great variation
in outcomes and ability to translate interventions into clinical practice.
This exploratory randomized controlled trial will test an 8-week behavioral intervention to
improve medication adherence in older adults with hypertension.
- Participants will be aged 60 years or greater at time of study entry.
- Participants must be able to read, write, and converse in English.
- Participants will have a diagnosis of hypertension (based on participant report).
- Participants will have an active prescription for at least one antihypertensive
medication with no antihypertensive prescription changes for 30 days at the time of
- Participants must self-administer his or her own medications without prompts from any
other person or device.
- Baseline medication adherence rate of < 85%.
- Participants must be free of cognitive deficit as determined by a score of "normal"
(0 - 2) on the Short Portable Mental Status Questionnaire (SPMSQ).
- Participants agree to complete all study contacts and measurements, including the use
a special medication bottle with a Medication Event Monitoring System (MEMS) cap for
the duration of the study.
- Able to open and close MEMS caps.
- Participant is in state of severe hypertension (BP of >180/120 mmHg) at the time of
study enrollment. Participants presenting with severely elevated blood pressure will
be referred to their primary care provider.
- Participant resides in a residential facility where medications are administered by
facility staff. Participants who reside in assisted living facilities but maintain
control of their medications remain eligible.
- Participant has a terminal chronic illness with a life expectancy of six months or