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Abstract
The PAM intervention is a behavioural intervention to support adherence to anti-hypertensive medications and therefore to lower blood pressure. This feasibility trial recruited 101 nonadherent patients (54% male, mean age 65.8 years) with hypertension and high blood pressure from nine general practices in the UK. The trial had 15.5% uptake and 7.9% attrition rate. Patients were randomly allocated to two groups: the intervention group (n = 61) received the PAM intervention as an adjunct to usual care; the control group (n = 40) received usual care only. At 3 months, biochemically validated medication adherence was improved by 20% (95% CI 3–36%) in the intervention than control, and systolic blood pressure was reduced by 9.16 mmHg (95% CI 5.69–12.64) in intervention than control. Improvements in medication adherence and reductions in blood pressure suggested potential intervention effectiveness. For a subsample of patients, improvements in medication adherence and reductions in full lipid profile (cholesterol 1.39 mmol/mol 95% CI 0.64–1.40) and in glycated haemoglobin (3.08 mmol/mol, 95% CI 0.42–5.73) favoured the intervention. A larger trial will obtain rigorous evidence about the potential clinical effectiveness and cost-effectiveness of the intervention.
Trial registration Trial date of first registration 28/01/2019. ISRCTN74504989. https://doi.org/10.1186/ISRCTN74504989.
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1 University of Cambridge, Department of Public Health and Primary Care, The Primary Care Unit, Cambridge, UK (GRID:grid.5335.0) (ISNI:0000000121885934)
2 University of Cambridge, Department of Computer Science and Technology, Cambridge, UK (GRID:grid.5335.0) (ISNI:0000000121885934); University of Southampton, School of Electronics and Computer Science, Southampton, UK (GRID:grid.5491.9) (ISNI:0000 0004 1936 9297)
3 University of East Anglia, School of Pharmacy, Norwich, UK (GRID:grid.8273.e) (ISNI:0000 0001 1092 7967)
4 University of East Anglia, School of Health Sciences, Norwich, UK (GRID:grid.8273.e) (ISNI:0000 0001 1092 7967)
5 Usher Institute, University of Edinburgh, Edinburgh, UK (GRID:grid.4305.2) (ISNI:0000 0004 1936 7988)
6 Queen Mary University of London, Institute of Population Health Sciences, London, UK (GRID:grid.4868.2) (ISNI:0000 0001 2171 1133)
7 Cambridgeshire and Peterborough Clinical Commissioning Group, Cambridge, UK (GRID:grid.4868.2)
8 University Hospitals of Leicester NHS Trust, Department of Metabolic Medicine and Chemical Pathology, Leicester, UK (GRID:grid.269014.8) (ISNI:0000 0001 0435 9078)
9 University of Cambridge, Department of Computer Science and Technology, Cambridge, UK (GRID:grid.5335.0) (ISNI:0000000121885934)
10 King’s College London, Nightingale-Saunders Clinical Trials and Epidemiology Unit, London, UK (GRID:grid.13097.3c) (ISNI:0000 0001 2322 6764)
11 University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948)