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Chemical Adherence Testing for Assessing Adherence to Antihypertensive Medications: A Systematic Review and Meta-Analysis of Prevalence of Nonadherence.

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Title: Chemical Adherence Testing for Assessing Adherence to Antihypertensive Medications: A Systematic Review and Meta-Analysis of Prevalence of Nonadherence.
Authors: Highton, Patrick J. (AUTHOR), Funnell, Mark P. (AUTHOR), Lane, Dan (AUTHOR), Vigneswara, Vasanthy (AUTHOR), Jenkins, Sian (AUTHOR), Kacha, Ghanshyam (AUTHOR), Gillies, Clare L. (AUTHOR), Gupta, Pankaj (AUTHOR), Khunti, Kamlesh (AUTHOR)
Source: Behavioral Medicine. Oct-Dec2025, Vol. 51 Issue 4, p265-279. 15p.
Subjects: Patient compliance, Medical information storage & retrieval systems, Research funding, Liquid chromatography-mass spectrometry, Hypertension, CINAHL database, Antihypertensive agents, Meta-analysis, Disease prevalence, Descriptive statistics, Systematic reviews, Serum, MEDLINE, Gas chromatography, Blood plasma, Medical databases, Mass spectrometry, Sociodemographic factors, Confidence intervals, Systolic blood pressure, Data analysis software, Regression analysis
Abstract: Nonadherence to antihypertensive medications is highly prevalent, driving cardiovascular risk. Chemical adherence testing (CAT) can detect the presence of medications or their metabolites in bodily fluid, though it is unclear if its use to date has been equitable. This review aimed to identify the demographics with hypertension in which CAT has been used previously, and to estimate the resulting prevalence of nonadherence. Multiple databases were searched from 2013 to February 2024. We included any published paper that reported CAT data in people with hypertension. Extracted data included: study design and setting, hypertension definition and type, participant sociodemographic factors, and prevalence of nonadherence. Data were synthesized using a random effects meta-analysis with meta-regression, or narrative synthesis. Seventy eligible papers were identified. Many papers did not present key participant sociodemographic data, including ethnicity or socioeconomic, educational or disability status. Most studies were completed in tertiary care settings, and in primarily White patients with apparent treatment-resistant hypertension. The estimated pooled prevalence of complete medication nonadherence was 15.0%, increasing to 33.0% when estimating any kind of nonadherence; heterogeneity was high in both analyses (I2 of 94.6% and 95.6%, respectively). Nonadherent patients had higher blood pressure and were prescribed more antihypertensive medications, whilst participant age showed an inverse relationship with prevalence of nonadherence. Key relevant sociodemographic factors were often not reported, limiting the understanding of CAT use in diverse populations. In order to support behavior change interventions to address medication nonadherence in underserved groups, future research should recruit diverse populations to inform equitable implementation. Review protocol registration: International Prospective Register of Systematic Reviews CRD42024505602. [ABSTRACT FROM AUTHOR]
Copyright of Behavioral Medicine is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Chemical Adherence Testing for Assessing Adherence to Antihypertensive Medications: A Systematic Review and Meta-Analysis of Prevalence of Nonadherence.
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  Data: <searchLink fieldCode="JN" term="%22Behavioral+Medicine%22">Behavioral Medicine</searchLink>. Oct-Dec2025, Vol. 51 Issue 4, p265-279. 15p.
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– Name: Abstract
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  Data: Nonadherence to antihypertensive medications is highly prevalent, driving cardiovascular risk. Chemical adherence testing (CAT) can detect the presence of medications or their metabolites in bodily fluid, though it is unclear if its use to date has been equitable. This review aimed to identify the demographics with hypertension in which CAT has been used previously, and to estimate the resulting prevalence of nonadherence. Multiple databases were searched from 2013 to February 2024. We included any published paper that reported CAT data in people with hypertension. Extracted data included: study design and setting, hypertension definition and type, participant sociodemographic factors, and prevalence of nonadherence. Data were synthesized using a random effects meta-analysis with meta-regression, or narrative synthesis. Seventy eligible papers were identified. Many papers did not present key participant sociodemographic data, including ethnicity or socioeconomic, educational or disability status. Most studies were completed in tertiary care settings, and in primarily White patients with apparent treatment-resistant hypertension. The estimated pooled prevalence of complete medication nonadherence was 15.0%, increasing to 33.0% when estimating any kind of nonadherence; heterogeneity was high in both analyses (I2 of 94.6% and 95.6%, respectively). Nonadherent patients had higher blood pressure and were prescribed more antihypertensive medications, whilst participant age showed an inverse relationship with prevalence of nonadherence. Key relevant sociodemographic factors were often not reported, limiting the understanding of CAT use in diverse populations. In order to support behavior change interventions to address medication nonadherence in underserved groups, future research should recruit diverse populations to inform equitable implementation. Review protocol registration: International Prospective Register of Systematic Reviews CRD42024505602. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Behavioral Medicine is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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    Identifiers:
      – Type: doi
        Value: 10.1080/08964289.2025.2503201
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      – Code: eng
        Text: English
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    Subjects:
      – SubjectFull: Patient compliance
        Type: general
      – SubjectFull: Medical information storage & retrieval systems
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      – SubjectFull: Research funding
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      – SubjectFull: Liquid chromatography-mass spectrometry
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      – SubjectFull: Hypertension
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      – SubjectFull: CINAHL database
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      – SubjectFull: Antihypertensive agents
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      – SubjectFull: Disease prevalence
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      – SubjectFull: Systematic reviews
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      – SubjectFull: Serum
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      – SubjectFull: MEDLINE
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      – SubjectFull: Gas chromatography
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      – SubjectFull: Regression analysis
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      – TitleFull: Chemical Adherence Testing for Assessing Adherence to Antihypertensive Medications: A Systematic Review and Meta-Analysis of Prevalence of Nonadherence.
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              Text: Oct-Dec2025
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