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CLINICAL STATEMENTS AND GUIDELINES

September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e198

10.	 Abdalla M, Bolen SD, Brettler J, et al. Implementation strategies to improve blood pressure control in the United States: a scientific statement from the American Heart Association and American Medical Association. Hyperten­ sion. 2023;80:e143-e157. 11.	 He J, Ouyang N, Guo X, et al. Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial. Lancet. 2023;401:928–938. 12.	 Law M, Wald N, Morris J, et al. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ. 2003;326:1427. 13.	 Bangalore S, Kamalakkannan G, Parkar S, et al. Fixed-dose combi­ nations improve medication compliance: a meta-analysis. Am J Med. 2007;120:713–719. 14.	 Du LP, Cheng ZW, Zhang YX, et al. The impact of fixed-dose combination versus free-equivalent combination therapies on adherence for hyperten­ sion: a meta-analysis. J Clin Hypertens (Greenwich) 2018;20:902–907. 15.	 Bellows BK, Ruiz-Negron N, Bibbins-Domingo K, et al. Clinic-based strate­ gies to reach United States Million Hearts 2022 blood pressure control goals. Circ Cardiovasc Qual Outcomes. 2019;12:e005624. 16.	 Ratanawongsa N, Zikmund-Fisher BJ, Couper MP, et al. Race, ethnicity, and shared decision making for hyperlipidemia and hypertension treatment: the DECISIONS survey. Med Decis Making. 2010;30:65S-76S. 17.	 Joint National Committee on Prevention Treatment of High Blood Pressure National High Blood Pressure Education Program. Report of the Joint Na­ tional Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Public Health Service, National Institutes of Health, National Heart and Lung; 1997. 18.	 US Food and Drug Administration. Approved drug products with therapeu­

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5.2.5 Antihypertensive Medication Adherence Strategies

1 Weeda ER, Coleman CI, McHorney CA, et al. Impact of once- or twice-daily

dosing frequency on adherence to chronic cardiovascular disease medica­ tions: a meta-regression analysis. Int J Cardiol. 2016;216:104–109. 2.	 Iskedjian M, Einarson TR, MacKeigan LD, et al. Relationship between daily dose frequency and adherence to antihypertensive pharmacotherapy: evi­ dence from a meta-analysis. Clin Ther. 2002;24:302–316. 3.	 Schroeder K, Fahey T, Ebrahim S. How can we improve adherence to blood pressure-lowering medication in ambulatory care? Systematic review of ran­ domized controlled trials. Arch Intern Med. 2004;164:722–732. 4.	 Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hy­ pertension. 2010;55:399–407. 5.	 Du LP, Cheng ZW, Zhang YX, et al. The impact of fixed-dose combination versus free-equivalent combination therapies on adherence for hyperten­ sion: a meta-analysis. J Clin Hypertens (Greenwich). 2018;20:902–907. 6.	 Webster R, Salam A, de Silva HA, et al. Fixed low-dose triple combination antihypertensive medication vs usual care for blood pressure control in pa­ tients with mild to moderate hypertension in Sri Lanka: a randomized clinical trial. JAMA. 2018;320:566–579. 7.	 Lauffenburger JC, Tesfaye H, Solomon DH, et al. Investigating the abil­ ity to adhere to cardiometabolic medications with different properties: a retrospective cohort study of >500 000 patients in the USA. BMJ Open. 2023;13:e075840. 8.	 Nsiah I, Imeri H, Jones AC, et al. The impact of medication synchronization programs on medication adherence: a meta-analysis. J Am Pharm Assoc (2003). 2021;61:e202-e211. 9.	 Nguyen E, Sobieraj DM. The impact of appointment-based medication syn­ chronization on medication taking behaviour and health outcomes: a sys­ tematic review. J Clin Pharm Ther. 2017;42:404–413. 10.	 Al-Arkee S, Mason J, Lane DA, et al. Mobile apps to improve medication adherence in cardiovascular disease: systematic review and meta-analysis. J Med Internet Res. 2021;23:e24190. 11.	 Choudhry NK, Krumme AA, Ercole PM, et al. Effect of reminder devices on medication adherence: the REMIND randomized clinical trial. JAMA Intern Med. 2017;177:624–631. 12.	 Conversano C, Orru G, Pozza A, et al. Is mindfulness-based stress reduction effective for people with hypertension? A systematic review and meta-analysis of 30 years of evidence. Int J Environ Res Public Health. 2021;18:2882. 13.	 Morawski K, Ghazinouri R, Krumme A, et al. Association of a smartphone

application with medication adherence and blood pressure control: the MedISAFE-BP randomized clinical trial. JAMA Intern Med. 2018;178:802– 809. 14.	 Van Truong P, Wulan Apriliyasari R, Lin MY, et al. Effects of self-

management programs on blood pressure, self-efficacy, medication adher­ ence and body mass index in older adults with hypertension: meta-analysis of randomized controlled trials. Int J Nurs Pract. 2021;27:e12920. 15.	 Reeves L, Robinson K, McClelland T, et al. Pharmacist interventions in the management of blood pressure control and adherence to antihypertensive medications: a systematic review of randomized controlled trials. J Pharm Pract. 2021;34:480–492. 16.	 Xu H, Long H. The effect of smartphone app-based interventions for pa­ tients with hypertension: systematic review and meta-analysis. JMIR Mhealth Uhealth. 2020;8:e21759. 17.	 Abegaz TM, Shehab A, Gebreyohannes EA, et al. Nonadherence to antihy­ pertensive drugs: a systematic review and meta-analysis. Medicine (Balti­ more). 2017;96:e5641. 18.	 Lee EKP, Poon P, Yip BHK, et al. Global burden, regional differences, trends, and health consequences of medication nonadherence for hypertension during 2010 to 2020: a meta-analysis involving 27 million patients. J Am Heart Assoc. 2022;11:e026582. 19.	 Brinker S, Pandey A, Ayers C, et al. Therapeutic drug monitoring facili­ tates blood pressure control in resistant hypertension. J Am Coll Cardiol. 2014;63:834–835. 20.	 Pandey A, Raza F, Velasco A, et al. Comparison of Morisky Medication Adherence Scale with therapeutic drug monitoring in apparent treatmentresistant hypertension. J Am Soc Hypertens. 2015;9:420–426.e422. 21.	 Choudhry NK, Kronish IM, Vongpatanasin W, et al. Medication adherence and blood pressure control: a scientific statement from the American Heart Association. Hypertension. 2022;79:e1-e14. 22.	 Peeters LEJ, Kappers MHW, Hesselink DA, et al. Antihypertensive drug concentration measurement combined with personalized feedback in resistant hypertension: a randomized controlled trial. J Hypertens. 2024;42:169–178. 23.	 Calderon-Larranaga A, Diaz E, Poblador-Plou B, et al. Non-adherence to antihypertensive medication: the role of mental and physical comorbidity. Int J Cardiol. 2016;207:310–316. 24.	 Alvarez C, Hines AL, Carson KA, et al. Association of perceived stress and discrimination on medication adherence among diverse patients with un­ controlled hypertension. Ethn Dis. 2021;31:97–108. 25.	 Bautista LE, Vera-Cala LM, Colombo C, et al. Symptoms of depression and anxiety and adherence to antihypertensive medication. Am J Hypertens. 2012;25:505–511. 26.	 Taft C, Hallberg I, Bengtsson U, et al. Links between blood pressure and medication intake, well-being, stress, physical activity and symptoms report­ ed via a mobile phone-based self-management support system: a cohort study in primary care. BMJ Open. 2018;8:e020849. 27.	 Stamoulis T, Dragioti E, Gouva M, et al. Unveiling the Nexus: depressive symptoms and medication adherence in hypertensive patients' self-care: a systematic review. Mater Sociomed. 2024;36:65–72. 28.	 Farhadi F, Aliyari R, Ebrahimi H, et al. Prevalence of uncontrolled hyper­ tension and its associated factors in 50-74 years old Iranian adults: a population-based study. BMC Cardiovasc Disord. 2023;23:318. 29.	 Qi M, Santos H, Pinheiro P, et al. Demographic and socioeconomic deter­ minants of access to care: a subgroup disparity analysis using new equityfocused measurements. PLoS One. 2023;18:e0290692. 30.	 Schesing KB, Chia R, Elwood B, et al. Assessment of patient and provider attitudes towards therapeutic drug monitoring to improve medication ad­ herence in low-income patients with hypertension: a qualitative study. BMJ Open. 2020;10:e039940. 31.	 Mackenzie IS, Rogers A, Poulter NR, et al. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual an­ tihypertensives in the UK (TIME study): a prospective, randomised, openlabel, blinded-endpoint clinical trial. Lancet. 2022;400:1417–1425. 32.	 Geiger C, Cramer H, Dobos G, et al. A systematic review and meta-analysis of mindfulness-based stress reduction for arterial hypertension. J Hum Hy­ pertens. 2023;37:161–169. 33.	 Lee EKP, Yeung NCY, Xu Z, et al. Effect and acceptability of mindfulnessbased stress reduction program on patients with elevated blood pressure or hypertension: a meta-analysis of randomized controlled trials. Hypertension. 2020;76:1992–2001. 34.	 Zaugg V, Korb-Savoldelli V, Durieux P, et al. Providing physicians

with feedback on medication adherence for people with chronic dis­ eases taking long-term medication. Cochrane Database Syst Rev 2018;1:CD012042.

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