O. Voloshyna, V. Zbitnieva, I. Lisiy, T. Dychko, V. Samorukova, O. Dukova
Odessa National Medical University
Introduction. The prevalence of arterial hypertension in Ukraine reaches 35.0 % among the adult population. The frequency of cases of resistant hypertension in the population of patients with hypertension varies from 5.0 to 18.0 %. In the structure of resistant arterial hypertension, pseudoresistant is observed in 90.0-95.0 % of cases.
Aim. To compare the various methods of the differential diagnosis of essential resistant and pseudoresistant arterial hypertension in the practice of a doctor of general practice.
Materials and methods. 120 patients with uncontrolled essential arterial hypertension, taking three antihypertensive drugs, and randomly divided into two groups – the main group – 60 patients (26 (43.3%) women and 34 (56.7 %) men, middle age 54.6 ± 9.2 years) and comparison group – 60 patients (24 (40.0 %) women and 36 (60.0 %) men, middle age 55.4 ± 8.5 years) were examined. The study consisted of three stages. At the first stage, the differential diagnosis of essential resistant and pseudoresistant arterial hypertension, using the method proposed by us for the patients from the main group was performed. Subsequently, the patients with detected by our acute pharmacological test pseudoresistant arterial hypertension continued to participate in the study and to take three previously assigned antihypertensive drugs in maximal tolerated doses in order to evaluate the sensitivity and specificity of our method and to verify the authenticity of pseudoresistant arterial hypertension by the traditional method. At the second stage, the differential diagnosis of essential resistant and pseudoresistant arterial hypertension using the traditional method for the patients from the comparison group was performed and the frequency of resistant and pseudoresistant arterial hypertension in both groups was determined. In the third stage, the assessment of the parameters of office blood pressure in the patients of both groups was performed on each visit.
Results. Based on the conducted research, the effectiveness of the new method of differential diagnosis of essential resistant and pseudoresistant arterial hypertension in the reduction of the timing of the diagnosis of pseudoresistant arterial hypertension and the faster achievement of blood pressure control in this category of patients is scientifically substantiated.
Conclusions. The sensitivity of the proposed method of differential diagnosis of essential resistant and pseudoresistant arterial hypertension, in comparison with the traditional one, is 95.7 % (95% CI 91.8-99.6), the specificity is 57.2 % (95% CI 47.5-66.9), the accuracy index (diagnostic value of the test) is 86.7 % (95% CI 80.1-93.3), compared to the traditional one.
The frequency of pseudoresistant arterial hypertension detection in the comparison group of patients was 80.0 %, in the main group – 88.0 %, the incidence of resistant arterial hypertension was 20.0 and 12.0 %, respectively = 1.7; df = 1; p > 0.05).
The application of the developed by us method of differential diagnosis of essential resistant and pseudoresistant arterial hypertension can significantly reduce the timing of differential diagnosis and accelerate the timing of the diagnosis of pseudoresistant arterial hypertension – to 3.9 і 2.6 days, compared with the traditional method – 16.4 і 6.8 days (p < 0.05), that allows to achieve the significant reduction of systolic blood pressure (>10.0% of the baseline level) on average 4.5 і 1.5 days earlier than using the traditional method – 20.2 і 3.6 days (p < 0.05).
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