O. Voloshyna, T. Dychko, I. Lysyi, V. Zbitneva
Odessa National Medical University
Introduction. For today, the treatment of patients with comorbid pathology arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD) remains insufficiently effective. The reason for this may be not only mutually aggravating course of these diseases, but also violations of adherence to antihypertensive and bronchodi-lator therapy in this category of patients.
Aim. To determine the effectiveness of patient – oriented correction of adherence to treatment in patients with comorbid pathology arterial hypertension and chronic obstructive pulmonary disease after determining and eliminating the main causes of violations of adherence to antihypertensive (AHT) and bronchodilator treatment (BDT).
Materials and methods. 94 patients with the established diagnosis of stage II hypertension and COPD of the 2nd or 3rd clinical groups (groups B and C) were examined, divided into two groups: the main group – 51 patients (54.3 %) with hypertension and concomitant COPD and comparison group – 43 patients (45.7 %) with essential hypertension. The data were analyzed by office and home blood pressure monitoring, spirometry parameters, the results of the questionnaires mMRS (modified Medical Research Council), CAT (COPD Assessment Test) and D. E. Morisky – L. W. Green’s commitment to the treatment.
Results. It was found that in patients with AH and concomitant COPD, in addition to the significant reduction in overall adherence to treatment, low attachment to bronchodilator therapy is more often than antihypertensive: 84.3 ± 5.1 % and 64.7 ± 6.7 % respectively (p < 0.02). Conducting the patient-oriented correction of adherence to treatment leads to significantly better control of blood pressure in patients with hypertension associated with COPD – in 73.1 ± 6.9 % of COPD patients in clinical group B and only in 57.6 ± 5.3 % of patients with clinical group C (p < 0,02) and improves the function of external respiration, including FEVj/FVC at 9.4 ± 4.1 % (p < 0,05).
Conclusions. In patients with comorbid pathology of AH and COPD, in addition to the significant reduction in overall adherence to treatment, low bronchodilator tolerance is significantly more common than antihypertensive therapy. Conducting the patient-oriented correction of adherence to treatment leads to significantly better control of blood pressure in patients with hypertension associated with COPD and improves the function of external respiration.
- Abrahamovych OO, Fayura OP, Abrahamovych UO. Comorbidity: a modern view on the problem; classification (first notice). Lviv Clinical Bulletin. 2015;4(12):56-64. (Ukrainian). https://doi.org/10.25040/lkv2015.04.056
- Abrahamovych OO, Fayura OP, Abrahamovych UO. Comorbidity: a modern view on the problem; classification (second notice). Lviv Clinical Bulletin. 2016;1(13):31-39. (Ukrainian). https://doi.org/10.25040/lkv2016.01.031
- Nastroga TV. Optimization of the treatment of comorbid pathology – arterial hypertension in combination with chronic obstructive pulmonary disease in the practice of a family doctor. Family Medicine. 2015;3(59):95-98. (Ukrainian).
- Sirenko YM. Medical and social problems of cardiac care in Ukraine: ways of solving. Problems of Continuous Medical Education and Science. 2014;2:6-10. (Ukrainian).
- Unified clinical protocol for primary, emergency and secondary (specialized) medical aid “Arterial hypertension”. Order of the Ministry of Health of Ukraine No. 384 dated 24.05.2012. [Internet]. 2012. Available from: http://mtd.dec.gov.ua/images/dodatki/384_2012/384_2012_kn_ag.pdf. (Ukrainian).
- Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) medical aid and medical rehabilitation “Chronic Obstructive Pulmonary Disease”. Order of the Ministry of Health of Ukraine No. 555 dated June 27, 2013. [Internet]. 2013. Available from: http://mtd.dec.gov.ua/images/dodatki/2013_555_HOZL/2013_555hozl_ykpmd.pdf. (Ukrainian).
- Fadeenko DG, Grindnev OE, Nessen AO. Comorbidity and high cardiovascular risk are the key issues of modern medicine. Ukrainian Therapeutic Journal. 2013;1:102-107. (Ukrainian).
- Bestall JC, Paul EA, Garrod R. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. 1999;54(7):581-586. https://doi.org/10.1136/thx.54.7.581
- Chow CK, Teo KK, Rangarajan S. PURE Study Investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013;310:959-968. https://doi.org/10.1001/jama.2013.184182
- Franssen FM. Comorbidities in patients with COPD and pulmonary rehabilitation: do they matter? Pulmonary Rehabilitation. 2014;23:131-14. https://doi.org/10.1183/09059180.00007613
- Global Initiative for Chronic Obstructive Lung Diseases (GOLD) [Internet] Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease [updated 2018]. Available from: https://goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS.pdf
- Jones P, Harding G, Berry P. Development and first validation of the COPD Assessment Test. Eur Resp J. 2009;34(3):648-654. https://doi.org/10.1183/09031936.00102509
- Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. J Med Care. 1986;24(1):67-74. https://doi.org/10.1097/00005650-198601000-00007
- NCD Risk Factor Collaboration. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet. 2017;389:37-55. https://doi.org/10.1016/S0140-6736(16)31919-5