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Background: Lack of medication adherence is a common reason for poor control of blood pressure in the community, increasing the risk of heart attacks and strokes.

Objective: To evaluate the effect of nurse-led adherence support for people with uncontrolled high blood pressure compared with usual care.

Methods: We recruited 245 women and men with uncontrolled hypertension (>=150/90 mmHg) from 21 general practices in Bristol, UK. Participants were randomized to receive nurse-led adherence support or usual care alone. Main outcome measures were adherence to medication ('timing compliance') and blood pressure.

Results: Mean baseline timing compliance ( /- SD) was high in both the intervention (90.8 /- 15.6%) and the control group (94.5 /- 7.6%). There was no evidence of an effect of the intervention on timing compliance at follow-up (adjusted difference in means -1.0%; 95% confidence interval (CI) -5.1 to 3.1). There was also no difference at follow-up between the groups with regard to systolic blood pressure (-2.7 mmHg; 95% CI -7.2 to 1.8) or diastolic blood pressure (0.2 mmHg; 95% CI -1.9 to 2.3). Projected costs for the primary care sector per consultation were [pounds]6.60 for the intervention compared with [pounds]5.08 for usual care.

Conclusion: In this study, adherence to blood pressure medication was much higher than previously reported. There was no evidence of an effect of nurse-led adherence support on medication adherence or blood pressure compared with usual care. Nurse-led adherence support was also more expensive from a primary care perspective.

(C) Copyright Oxford University Press 2005.