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CONCOMITANT CARDIOVASCULAR DISEASES AND ANTIHYPERTENSIVE TREATMENT IN OUTPATIENT PRACTICE (BY THE RECVASA REGISTRY DATA)

https://doi.org/10.20996/1819-6446-2016-12-1-4-15

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Abstract

Aim. To study a pattern of concomitant cardiovascular diseases (CVDs) and to estimate particularities and quality of medical antihypertensive therapy in hypertensive patients in real outpatient practice with a help of the Registry in Ryazan region.

Material and methods. A total of 3690 patients with hypertension, ischemic heart disease, chronic heart failure and atrial fibrillation, who had attended general practitioners and cardiologists of 3 outpatient clinics in Ryazan city, were enrolled in the outpatient Registry of cardiovascular diseases (RECVASA). The diagnosis of hypertension was recorded in 3648 of 3690 (98.9%) outpatient charts, 28.1% of the subjects were men and 71.9% - women.

Results. A total of 2907 (79.7%) of 3648 patients had combination of hypertension with other CVDs. Combination of 3-4 cardiovascular diagnoses was registered in 63.8% of the cases. 11.5% and 9.5% of the patients had a history of myocardial infarction and cerebral stroke, respectively. Diagnosis of hypertension was verified in 448 of 450 randomized hypertensive patients (99.6%). The incidence of prescription of one and two antihypertensive drugs (AHDs) was 25% and 39%, respectively, of 3 AHDs – 21%, 4 and more – 2%. AHDs were not prescribed in 13% of hypertensive patients. The mean number of prescribed AHDs was 1.73. The mean incidence rate of target blood pressure achievement was 26.1%. We have noted insufficient ACE inhibitors/angiotensin receptor blockers (ARB) and beta-blockers prescription in different concomitant CVDs. Patients with 3-4 cardiovascular diagnoses were more often prescribed combined antihypertensive treatment. Prescription of ACE inhibitors/ARB, beta-blockers and thiazide diuretics combination was preferable in 74.1% of the cases, when taking into account absolute and relative contraindications for betablockers use – in 64.0%. 15.2% of the hypertensive patients used reimbursed drugs for CVDs at the moment of the Registry enrollment as compared with 39.2% in previous years (p<0.05).

Conclusion. The RECVASA study data allowed revealing high incidence of concomitant CVDs in hypertensive patients, insufficient use of combined antihypertensive treatment, including AHDs with proved favorable influence on prognosis. Achievement of concordance of medical treatment to national and international guidelines, taking into account concomitant CVDs, and optimization of patients’ coverage with reimbursed drugs are the main reserves for antihypertensive treatment quality improvement.

About the Authors

M. M. Loukianov
State Scientific Research Center for Preventive Medicine Petroverigsky per. 10, Moscow, 101990 Russia
Russian Federation

MD, PhD, Leading Researcher of the Department of Clinical Cardiology and Molecular Genetics, State Research Center for Preventive Medicine (SRC PM)



S. A. Boytsov
State Scientific Research Center for Preventive Medicine Petroverigsky per. 10, Moscow, 101990 Russia

MD, PhD, Professor, Head of the same Department, Director of the SRC PM



S. S. Yakushin
Ryazan State Medical University named after academician I.P. Pavlov Visokovoltnaya ul. 9, Ryazan, 390026 Russia

MD, PhD, Professor, Head of Chair of Hospital Therapy, Ryazan State Medical University (RyazSMU)



S. Yu. Martsevich
State Scientific Research Center for Preventive Medicine Petroverigsky per. 10, Moscow, 101990 Russia

MD, PhD, Professor, Head of Department of Preventive Pharmacotherapy, SRC PM



A. N. Vorobyev
Ryazan State Medical University named after academician I.P. Pavlov Visokovoltnaya ul. 9, Ryazan, 390026 Russia

MD, PhD, Assistant of Chair of Hospital Therapy, RyazSMU



A. V. Zagrebelnyy
State Scientific Research Center for Preventive Medicine Petroverigsky per. 10, Moscow, 101990 Russia

MD, PhD, Senior Researcher of Department of Preventive Pharmacotherapy, SRC PM



N. N. Nikulina
Ryazan State Medical University named after academician I.P. Pavlov Visokovoltnaya ul. 9, Ryazan, 390026 Russia

MD, PhD, assistant professor of the Chair of Hospital Therapy, RyazSMU



K. G. Pereverzeva
Ryazan State Medical University named after academician I.P. Pavlov Visokovoltnaya ul. 9, Ryazan, 390026 Russia
MD, PhD student of the same chair


E. A. Pravkina
Ryazan State Medical University named after academician I.P. Pavlov Visokovoltnaya ul. 9, Ryazan, 390026 Russia
MD, PhD student of the same chair


A. D. Deev
State Scientific Research Center for Preventive Medicine Petroverigsky per. 10, Moscow, 101990 Russia

PhD, Head of Laboratory of Biostatistics, SRC PM



E. V. Kudryashov
State Scientific Research Center for Preventive Medicine Petroverigsky per. 10, Moscow, 101990 Russia

a programmer of the same laboratory



E. N. Belova
State Scientific Research Center for Preventive Medicine Petroverigsky per. 10, Moscow, 101990 Russia
a programmer of the same laboratory


References

1. WHO Global InfoBase. Available at: https://apps.who.int/infobase/Mortality.aspx. Accessed by 20.01.2016.

2. Go AS, Mozaffarian D, Roger VL, et al. Heart Disease and Stroke Statistics -2013 Update: A Report From the American Heart Association. Circulation 2013; 127: e6-e245.

3. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, eds. Global Burden of Disease and Risk Factors. Washington: Oxford University Press and World Bank; 2006.

4. Perk J., de Backer B.G., Gohlke H., et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J 2012;33: 1635-701.

5. Chazova I.E., Ratova L.G., Boytsov S.A., Nebieridse D.V. National guidelines for the diagnosis and treatment of hypertension (4th edition). Sistemnie Gypertensii 2010; 3: 5-26. In Russian (Чазова И.Е., Ратова Л.Г., Бойцов С.А., Небиеридзе Д.В. Диагностика и лечение артериальной гипертензии. Рекомендации Российского медицинского общества по артериальной гипертонии и Всероссийского научного общества кардиологов). Системные гипертензии 2010; 3: 5-26).

6. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013;34(28): 2159- 219.

7. James P.A., Oparil S., Carter B.L. et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 5: 507-20.

8. Chazova IE, Oshchepkova EV, Zhernakova YuV. Diagnosis and treatment of hypertension. Clinical guidelines. Kardiologicheskiy Vestnik 2015; 1: 3-30. In Russian (Чазова И.Е., Ощепкова Е.В., Жернакова Ю.В. Диагностика и лечение артериальной гипертонии. Клинические рекомендации. Кардиологический Вестник 2015; 1: 3-30).

9. Gliklich RE. Registries for Evaluating Patient Outcomes: A User’s Guide. Rockville, MD: Agency for Healthcare Research and Quality; 2010.

10. Boytsov SA, Martsevich SYu, Kutishenko NP, et al. Registers in cardiology. Basic rules of conduct and a real opportunity. Kardiovaskulyarnaya Terapiya i Profilaktika 2013; 12 (1); 4-9. In Russian (Бойцов С.А., Марцевич С.Ю., Кутишенко Н.П. и др. Регистры в кардиологии. Основные правила проведения и реальные возможности. Кардиоваскулярная Терапия и Профилактика 2013; 12 (1); 4-9).

11. Deepak L.B., J.P.Drozda, D.M.Shahian et al. ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement Enterprise. Circ Cardiovasc Qual Outcomes. 2015;8:634–48.

12. Oshchepkova EV, Dovgalevskiy PYa, Gridnev VI. Register hypertension. Ter Arkhiv 2007;79(1):46-8. In Russian (Ощепкова Е.В., Довгалевский П.Я., Гриднев В.И. Регистр артериальной гипертонии. Терапевтический Архив 2007;1:46-8).

13. Kiss I., Kekes E. Hungarian hypertension registry. Orv Hetil 2014; 155 (19): 764-8.

14. Juanatey J.R.G., Ezquerra E.A., Vidala J.V.L. et al. The Role of High Blood Pressure in Cardiac Diseases in Spain. The CARDIOTENS Study 1999. Rev Esp Cardiol 2001; 54: 139-49.

15. Boytsov SA, Yakushin SS, Martsevich SYu, et al. Outpatient polyclinic case of cardiovascular diseases in the Ryazan region (REKVASA): key challenges, the experience of creating and first results. Ration Pharmacother Cardiol 2013; 9 (1): 4-14. In Russian (Бойцов С.А., Якушин С.С., Марцевич С.Ю.

16. и др. Амбулаторно-поликлинический Регистр кардиоваскулярных заболеваний в Рязанской области (РЕКВАЗА): основные задачи, опыт создания и первые результаты. Рациональная Фармакотерапия в Кардиологии 2013; 9(1): 4-14).

17. Boytsov SA, Loukianov MM, Yakushin CC, et al. Cardiovascular diseases registry (RECVASA): diagnostics, concomitant cardiovascular pathology, comorbidities and treatment in the real outpatient-polyclinic practice. Kardiovaskulyarnaya Terapiya i Profilaktika 2014;13(6): 44-50. In Russian (Бойцов С.А., Лукьянов М.М., Якушин С.С. и др. Регистр кардиоваскулярных заболеваний (РЕКВАЗА): диагностика, сочетанная сердечно-сосудистая патология, сопутствующие заболевания и лечение в условиях реальной амбулаторно-поликлинической практики. Кардиоваскулярная терапия и профилактика 2014; 6: 44-50).

18. Zagrebelnyy AV, Martsevich SY, Loukianov MM et al. Quality assessment appointment of antihypertensive drugs to patients with arterial hypertension with no concomitant cardiovascular disease, as part of outpatient REKVAZA register. Ration Pharmacother Cardiol 2014; 5: 378-83. In Russian (Загребельный А.В., Марцевич С.Ю., Лукьянов М.М. с соавт. Оценка качества назначения антигипертензивных препаратов больным артериальной гипертонией, не имеющим сочетанной сердечно-сосудистой патологии, в рамках амбулаторно-поликлинического Регистра РЕКВАЗА. Рациональная фармакотерапия в кардиологии 2014; 5: 378-83).


For citation:


Loukianov M.M., Boytsov S.A., Yakushin S.S., Martsevich S.Y., Vorobyev A.N., Zagrebelnyy A.V., Nikulina N.N., Pereverzeva K.G., Pravkina E.A., Deev A.D., Kudryashov E.V., Belova E.N. CONCOMITANT CARDIOVASCULAR DISEASES AND ANTIHYPERTENSIVE TREATMENT IN OUTPATIENT PRACTICE (BY THE RECVASA REGISTRY DATA). Rational Pharmacotherapy in Cardiology. 2016;12(1):4-15. (In Russ.) https://doi.org/10.20996/1819-6446-2016-12-1-4-15

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