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IS IT POSSIBLE TO IMPROVE THE ADHERENCE TO TREATMENT OF HYPERTENSION AND DYSLIPIDEMIA IN PATIENTS WITHOUT CLINICAL MANIFESTATIONS OF ATHEROSCLEROSIS?

https://doi.org/10.20996/1819-6446-2017-13-5-602-608

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Abstract

The search for effective ways to improve adherence to medication in patients with hypertension at high risk is critical in reducing morbidity and mortality from cardiovascular diseases.

Aim. To assess the possibility of improving adherence to therapy in high-risk hypertensive patients with dyslipidemia by means of electronic version of the SCORE scale in primary care.

Material and methods. 300 hypertensive patients with dyslipidemia aged 40 to 65 years without clinical manifestations of atherosclerosis visiting primary care doctor  (departmental clinic of Moscow) were examined. The study included only patients (n=150) with high cardiovascular risk and target organ damages (microalbuminuria, left ventricular hypertrophy, subclinical carotid atherosclerosis). The patients were randomized into two groups – main (n=76) and control (n=74). All patients were prescribed antihypertensive and lipid-lowering therapy, recommendations for a healthy lifestyle. In the main group, the positive dynamics of risk was demonstrated with the electronic version of the SCORE scale in the case of achieving target levels of blood pressure (BP) and total cholesterol, smoking cessation and weight loss. No such demonstration was done in the reference group.  The duration of study was 12 months. In the groups, evaluation of the achievements of target BP values and lipid variables, risk factors correction, dynamics of SCORE risk and adherence to therapy was done.  Adherence to treatment was assessed by Morisky-Green scale.

Results. By the end of the study, the average Morisky-Green score in the main group was 2.14 vs 1.27 in the control group (p<0.001). In the main group, adherence to antihypertensive therapy persisted for 8.8 months, to statin therapy – 6.74 months; the same characteristics in the control group were 5.73 and 3.6 months, respectively (p<0.001). Achievement of target levels of BP and total cholesterol in the main group  amounted to 55.3% and 35.5% of patients, respectively, in the control group  – 18.9% and 10.8%, respectively (p<0.001). The SCORE risk value was significantly lower in the main group than this in control group (4.09 vs 5.25, respectively).

Conclusion. Demonstration of electronic version of SCORE scale for high-risk hypertensive patients with dyslipidemia allows increasing the patient's adherence to treatment. This leads to the increase in the effectiveness of therapy, better control of BP and lipid parameters, correction of other modifiable risk factors and as a result to reducing overall cardiovascular risk.

About the Authors

A. А. Sarycheva
Clinical Hospital №1, Administrative Department of the President of the Russian Federation
Russian Federation

Anna A. Sarycheva – MD, Therapist.

Starovolynskaya ul. 10,  Moscow, 121352



D. V. Nebieridze
National Medical Research Center for Preventive Medicine
Russian Federation

David V. Nebieridze – MD, PhD, Head of Department of Metabolic Disorders Prevention.

Petroverigsky per. 10-3, Moscow, 101990



T. V. Kamyshova
National Medical Research Center for Preventive Medicine
Russian Federation

Tatiana V. Kamyshova – MD, Senior Researcher,  Department of Metabolic Disorders Prevention.

Petroverigsky per. 10-3, Moscow, 101990



References

1. Shalnova S.A., Balanova Yu.A., Konstantinov V.V., et al. Arterial hypertension: prevalence, awareness, anti-hypertensive pharmaceutical treatment, treatment effectiveness in Russian population. Russian Journal of Cardiology. 2006;4:45-50. (In Russ) [Шальнова С.А., Баланова Ю.А., Константинов В.В. и др. Артериальная гипертония: распространенность, осведомленность, прием антигипертензивных препаратов и эффективность лечения среди населения Российской Федерации. Российский Кардиологический Журнал. 2006;4:45-50] doi: 0.15829/1560-4071-2006-4-45-50

2. Oganov R.G., Maslennikova G.Ya., Koltunov I.E., Kalinina A.M. The indispensable conditions or the prevention of cardiovascular and other non-infectious diseases in the Russian Federation. Cardiovascular Therapy and Prevention. 2010;9(6):4-9. (In Russ.) [Оганов Р.Г., Масленникова Г.Я., Колтунов И.Е., Калинина A.M. Необходимые условия для профилактики сердечно-сосудистых и других неинфекционных заболеваний в Российской Федерации. Кардиоваскулярная Терапия и Профилактика. 2010;9(6):4-9]

3. Julius S., Kjeldsen S.E., Weber M. et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipin: the VALUE ran-domised trial. Lancet. 2004;363(9426):2022-31. doi: 10.1016/S0140-6736(04)16451-9

4. Oganov R.G., Shalnova S.A., Kalinina A.M. Prevention of cardiovascular diseases. Leadership. Moscow: GEOTAR-Media; 2009. (In Russ.) [Оганов Р.Г., Шальнова С.А., Калинина А.М. Профилактика сердечно-сосудистых заболеваний. Руководство. Москва: ГЭОТАР-Медиа; 2009]

5. Posnenkova O.M., Kiselev A.P., Gridnev V.I., et al. Blood pressure control in primary care patients with arterial hypertension: analysing the Hypertension Register data. Cardiovascular Therapy and Prevention. 2012;11(3):4-11. (In Russ.) [Посненкова О.М., Киселев А.Р., Гриднев В.И., Шварц В.А., Довгалевский П.Я., Ощепкова Е.В. Контроль артериального давления у больных гипертонией в первичном звене здравоохранения. Анализ данных регистра артериальной гипертонии. Кардиоваскулярная Терапия и Профилактика. 2012;11(3):4-11]

6. Boytsov S.A., Kukharchuk V.V., Karpov Yu.A., et al. Subclinical atherosclerosis as a risk factor of cardiovascular events. Cardiovascular Therapy and Prevention. 2012;11(3):82-6. (In Russ.) [Бойцов С.А., Кухарчук В.В., Карпов Ю.А., и др. Субклинический атеросклероз как фактор риска сердечно-сосудистых осложнений. Кардиоваскулярная Терапия и Профилактика. 2012;11(3):82-6]

7. Gavrilova N.E., Meletskaya V.A., Yarovaya E.B., Boytsov S.A. Carotid artery duplex scan in diagnosing coronary atherosclerosis and assessing its severity. Profilakticheskaja Medicina. 2013;16(6):85-9. (In Russ.) [Гаврилова Н.Е., Метельская С.А., Бойцов С.А. Значение дуплексного сканирования сонных артерий в раннем выявлении коронарного атеросклероза. Профилактическая Медицина.2013;16(6):85-9]

8. Urazalina S.Zh., Boytsov S.A., Balakhonova T.V., et al. Trends in the risk factors and signs of subclinical atherosclerosis in subjects at low and moderate risk according to the SCORE scale in different medical management tactics: Two-year follow-up results. Ter Arkhive. 2012; 84: 9: 58-64. (In Russ.) [Уразалина С.Ж., Бойцов С.А., Балахонова Т.В., Кухарчук В.В., Карпов Ю.А. Динамика факторов риска и признаков субклинического атеросклероза у лиц с низким и умеренным риском по шкале SCORE при различной врачебной тактике ведения: итоги двухлетнего наблюдения. Терапевтический Архив. 2012;84(9):58-64]

9. Zhernakova Yu.V., Sharipova G.Kh., Chazova I.E. The risk of development of the lesions in the target organs of te patients presenting with arterial hypertension and the different number of the components of metabolic syndrome. Sistemnye Gipertenziiю 2014;11(1):40-4. (In Russ.) [Жернакова Ю.В., Шарипова Г.Х., Чазова И.Е. Риск поражения органов-мишеней у больных артериальной гипертонией с разным числом компонентов метаболического синдрома. Системные Гипертензии. 2014;11(1):40-4]

10. Puchin'yan N.F., DovgalevskiyYa.P., Dolotovskaya P.V., Furman N.V. The adherence to recommended therapy in patients after acute coronary syndrome, and risk of cardiovascular complications within a year after hospital admission. Rational Pharmacotherapy in Cardiology. 2011;7(5):567-73. (In Russ.) [Пучиньян Н.Ф., Довгалевский Я.П., Долотовская П.В., Фурман Н.В. Приверженность рекомендованной терапии больных, перенесших острый коронарный синдром, и риск развития сердечно-сосудистых осложнений в течение года после госпитализации. Рациональная Фармакотерапия в Кардиологии. 2011;7(5):567-73]. doi:10.20996/1819-6446-2011-7-5-567-573

11. Ford E.S., Ajani U.A., Croft J. B. et al. Explaining the decrease in U.S. deaths from coronary disease, 19802000. N Engl J Med. 2007;356(23):2388-98. doi: 10.1056/NEJMsa053935

12. Timofeeva T. N., Deev A. D., Shalnova S. A. Analytical report about the epidemiological situation for AH in 2008 and its dynamics from 2003 to 2008 at the three previous monitoring. 2009. Available: http://heartlib.ru/docs/index-2025.html. Checked: Oct 23, 2017. (In Russ.) [Тимофеева Т.Н., Деев А.Д., Шальнова С.А. Аналитическая справка об эпидемиологической ситуации по АГ в 2008 году и ее динамике с 2003 по 2008 год по трем проведенным мониторингам. 2009. Доступно: http://heartlib.ru/docs/index-2025.html. Проверено: 23.10.2017] 609-614

13. Leonova M.V., Belousov Y.B., Steinberg L.L., Galitskyi A.A., Belousov D.Y. Pharmaco-epidemiology of arterial hypertension in Russia: the results of the pharmacoepidemiological study PIFAGOR III. Russian Journal of Cardiology. 2011;(2):9-16. (In Russ.) [Леонова М.В., Ю. Б. Белоусов, Л. Л. Штейнберг, А. А. Галицкий, Д. Ю. Белоусов. Фармакоэпидемиология артериальной гипертонии в России (по результатам фармакоэпидемиологического исследования ПИФАГОР III). Российский Кардиологический Журнал. 2011;88(2):9-16]. doi:10.15829/1560-4071-2011-2-9-16

14. Khokhlov A. L., Lisenkov, L. A., Rakov A. A. Analysis of the determinants of adherence to antihypertensive therapy. Kachestvennaja Klinicheskaja Praktika. 2003;4:59-66. (In Russ.) [Хохлов А.Л., Лисенкова Л.А., Раков А.А. Анализ факторов, определяющих приверженность к антигипертензивной терапии. Качественная Клиническая Практика. 2003;4:59-66]

15. Perreault S., Perreault S., Lamarre D., et al. Collin Persistence with treatment in newly treated middleaged patients with essential hypertension. Ann Pharmacother. 2005;39(9):1401-8. doi:10.1111/j.1365-2125.2005.02355.x

16. Claxton A.J., Cramer J., Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23(8):1296-310. doi: 10.1016/S0149-2918(01)80109-0

17. Osterberg L., Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-97. doi: 10.1056/NEJMra050100

18. Martsevich S.Yu., Kutishenko N.P., Tolpygina S.N., et al. The efficacy and safety of drug therapy in primary and secondary prevention of cardiovascular diseases. Recommendations RSC, 2011. Rational Pharmacotherapy in Cardiology. 2011;5:2-72. (In Russ.) [Марцевич С.Ю., Кутишенко Н.П., Толпыгина С.Н., и др. Эффективность и безопасность лекарственной терапии при первичной и вторичной профилактике сердечно-сосудистых заболеваний. Рекомендации ВНОК, 2011. Рациональная Фармакотерапия в Кардиологии. 2011;5:2-72]. doi: 10.20996/1819-6446-2011-7-5


For citation:


Sarycheva A.А., Nebieridze D.V., Kamyshova T.V. IS IT POSSIBLE TO IMPROVE THE ADHERENCE TO TREATMENT OF HYPERTENSION AND DYSLIPIDEMIA IN PATIENTS WITHOUT CLINICAL MANIFESTATIONS OF ATHEROSCLEROSIS? Rational Pharmacotherapy in Cardiology. 2017;13(5):602-608. (In Russ.) https://doi.org/10.20996/1819-6446-2017-13-5-602-608

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