Determinantes sistémicos y estrategias multifacéticas para la adherencia al tratamiento antihipertensivo: Una revisión integrativa (2019-2025)
Palabras clave:
Hipertensión, Cumplimiento de la medicación, Inercia terapéutica, Telemedicina, Determinantes sociales de la saludResumen
Introducción: La hipertensión arterial sigue siendo el principal factor de riesgo modificable para enfermedad cardiovascular global. A pesar de la eficacia farmacológica, el control de la presión arterial es subóptimo debido a la falta de adherencia a la medicación. Esta revisión integrativa analiza los determinantes críticos de la no adherencia y evalúa la eficacia de estrategias de intervención emergentes.
Métodos: Se realizó una revisión integrativa bajo la metodología de Whittemore y Knafl. Se llevaron a cabo búsquedas en PubMed/MEDLINE y Scopus (2019-2025) para identificar estudios en adultos con hipertensión esencial. Se incluyeron investigaciones sobre barreras socioeconómicas, inercia terapéutica y factores psicosociales, así como intervenciones conductuales, tecnológicas (mHealth) y farmacológicas (polypill).
Resultados: La síntesis temática revela que la no adherencia está condicionada por barreras estructurales (costos, acceso rural), baja alfabetización en salud y factores psicosociales (depresión, aislamiento social). La inercia terapéutica del proveedor exacerba el descontrol tensional. Las estrategias más efectivas incluyen la simplificación del régimen mediante combinaciones a dosis fija (polypill), el uso de salud móvil (recordatorios SMS, telemonitoreo) para aumentar la autoeficacia, y el apoyo farmacéutico y familiar. Estas intervenciones se asociaron con reducciones de la presión arterial sistólica entre -3.9 y -6.1 mmHg y una disminución en hospitalizaciones.
Conclusiones: La adherencia es un fenómeno complejo que trasciende la conducta del paciente. Mejorar los desenlaces cardiovasculares requiere transitar desde un modelo prescriptivo hacia un abordaje colaborativo que integre tecnologías de monitoreo, simplificación terapéutica y soporte psicosocial para mitigar las barreras sistémicas.
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Derechos de autor 2025 Maria Eduarda Wiegert da Costa, Maiza Vitória Aguiar Silva Oliveira, Cecília Batista de Queiroz, Willian Michel Wermeier, Maria Fernanda de Abreu da Silva, Isabella Attisano Morato, Aurilene Coccia Prudencio, Diana de Faria Goldin, Andrea Paola Britos Gómez (Autor/a)
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
