EFFICIENCY OF TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION AND COMORBID STATES IN REAL CLINICAL PRACTICE
DOI:
https://doi.org/10.11603/2415-8798.2019.2.10002Keywords:
arterial hypertension, comorbidity, treatment efficacy, real practiceAbstract
The recommendations of the last 5 years underline the need to control concomitant risk factors in patients with arterial hypertension (АН) of high and very high risk. Antihypertensive (AHT) and prognosis-modifying therapy (PMT) in patients with AH should be prolonged and continued. One of the factors hindering this is poor patient‘s adherence to treatment. The clinical aspects of poor adherence include the polymorbid status of patients, which in connection with polypharmacy negatively impacts to persistence in following the recommendations of the doctor.
The aim of the study – to evaluate the effectiveness and identify the factors of ineffective treatment of patients with AH and comorbid conditions in real clinical practice for the further development of methods for their correction.
Materials and Methods. As а part of the research work “Detection of molecular genetic markers for selection, evaluation of the effectiveness of personalized pharmacotherapy for primary arterial hypertension with comorbid pathology” (state registration number 0114U007015, 2015–2019), 370 patients with AH of 1–3 grades, 31–88 years old, 164 (44 %) – men, 206 (56%) – women. At the inclusion of patients, it was assessed what AHT and its doses were prescribed, whether PMT was prescribed (statins, antiplatelet drugs), and their effectiveness. Charlson comorbid index was calculated.
Results and Discussion. The clinical portrait of a patient with hypertension in the study was determined by multiple vascular and metabolic comorbidity. More than 3 concomitant pathological conditions had 90.5 % of patients, which was the cause of polypharmacy. Five or more medications were taken daily by 21.2 % of patients. However, 7.8 % of patients at the time of inclusion had controlled hypertension only. Uncontrolled blood pressure, low rate of PMP prescription (rennin-angiotensin system inhibitors – 63.5 %, statins – 35.1 %, antiplatelet drugs – 59.5 %), and the inappropriate intensity of the therapy with statins contributes to the complicated course of hypertension in comorbid patients.
Conclusions. The strategies to improve adherence to the complex therapy of hypertensive patients with concomitant conditions and its individualization while coordinating the clinical pharmacologist are required to be developed.
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