K.M. Amosova, Іu.V. Rudenko. Adherence of patients with arterial hypertension to the algorithmic antihypertensive therapy in real-life clinical practice

The aim – to identify factors associated with adherence of patients with arterial hypertension (AH) to the algorithmic antihypertensive therapy and its impact upon the control of the office and home blood pressure (BP) in real-life clinical practice.

Materials and methods. The open-label prospective study included patients with uncomplicated essential hypertension, age 35 to 75 years, untreated with BP ≥ 160/100 mm Hg. and treated with BP ≥ 140/90 mm Hg. Step-by-step treatment algorithm included initial usage of fixed dose combination of perindopril and amlodipine and, if necessary, addition of indapamide retard, spironolactone, moxonidine or doxazosin to attain target office BP < 140/90 mm Hg. BP was measured by automatic oscillometric device with universal or individually selected cuff: office BP – at the 1st and at each subsequent visit (7 days, 1, 2, 3, and 6 months), home BP – twice daily, before breakfast and before bedtime for at least 7 consecutive days before visit to the doctor. Prior to the study, at the first visit and in all patients at the last visit adherence to treatment was determined using questionnaire (X. Girerd et al., 2001). Results. After 6 months of treatment high adherence to treatment was observed in 217 (49 %) patients (group 1), moderate – 193 (43.6 %) patients (group 2), low – in 33 (7.4 %) patients (group 3). In the first group, compared to the third one, we detected more patients untreated before the study (Р<0.03); but in the third group, as compared to the first and second – more smokers (Р<0.02). In the first group, the percentage of persons with high initial adherence to antihypertensive therapy was greater, and the low – less compared to that in the second and third groups (Р<0.01 and Р<0.001, respectively). In the third group after 6 months, the proportion of persons with target office BP, recommended home BP level and controlled hypertension was lower than that in the first and second groups (Р<0.01; Р<0.03; Р<0.01, respectively). Conclusions. Stepwise treatment algorithm based on a fixed combination of perindopril and amlodipine together with home BP control in patients with uncomplicated hypertension may significantly improve patients’ adherence to the treatment. High adherence to the treatment is associated with lower frequency of use of antihypertensive therapy in the past and, compared with low adherence, – increased frequency of well-controlled office and home BP at 6 months. Low adherence to the treatment in patients with uncontrolled hypertension is associated with smoking and greater frequency of apparent treatment resistant hypertension, until the appointment of algorithmic antihypertensive therapy.

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