Lviv clinical bulletin 2022, 1(37)-2(38): 28-35

https://doi.org/10.25040/lkv2022.01-02.028

Adherence to Treatment and Factors Influencing the Quality of Treatment of Hypertension in Patients in the Long Term After Myocardial Infarction

A. Yagensky, M. Pavelko

Komunalne Pidpryiemstvo Medychne Obiednannia Lutskoyi Miskoyi Terytorialnoyi Hromady

Introduction. Adherence to the treatment of arterial hypertension (AH) after myocardial infarction (MI) remains an understudied problem in world cardiology.

The aim of the study. Assess adherence to treatment and the factors that affect it in patients with AH in the remote period after MI.

Materials and methods. The study included 265 patients after MI (68.2 % of men, mean age 65.4 ± 9.5 years). The mean time from MI to inclusion in the study was 2.3 ± 1.9 years. Assessment of the quality of secondary prevention was performed by analyzing the results of the questionnaire, measuring of anthropometric parameters, blood pressure (BP) and heart rate (HR), as well as determining lipid metabolism, creatinine and venous blood glucose.

Results. The frequency of detection of AH in the long period after MI is 69.1 %, regardless of gender, time of MI and its variant and increases in proportion to age. Only in 26.3 % of patients with hypertension in the remote period after MI BP was within the target values. Factors associated with achieving the target values ​​of BP were age up to 60 years (OR – 1.35; p = 0.02), a visit to the doctor during the last 6 months (OR – 1.82; p = 0.002), regular independent blood pressure measurement (OR – 1.63; p = 0.01). 13.3 % of patients with AH after MI did not take antihypertensive drugs, the remaining 60.4 % of patients with AH were treated but did not reach the target BP. Among patients with AH after MI who did not take antihypertensive drugs, patients older than 60 years prevailed (83.3 % vs. 63.2 % of treated patients, p = 0.05). In addition, much less often these patients were under the supervision of a doctor – 47.4 % vs. 82.8 % (p = 0.0005), including a cardiologist (40.9 % vs. 75.0 %, p = 0.001), less visited a doctor for a year, had lower BP, and had poorer knowledge of post-MI treatment. In addition, none of them use statins. Patients with AH who received treatment but did not reach the target BP values ​​received the same amount of antihypertensive drugs as patients with controlled AH – an average of 2.1 ± 1.0 and 2.1 ± 0.9 drugs, respectively. At the same time, 29.3 % of patients in the group of ineffectively treated AH received monotherapy. No differences were found between age, sex, basic clinical and social parameters, financial status, health knowledge, self-measurement of blood pressure, or frequency of physician visits.

Conclusions. To achieve the target BP levels in patients with AH after MI, it is necessary to: introduce regular measurement of home BP in all patients; use combination antihypertensive therapy, including, if necessary, with the use of three or more drugs; regularly monitor adherence to treatment, use of antiplatelet, antihypertensive drugs and statins. Patients with difficult-to-control AH should consult a cardiologist at least every 6 months.

References

  1. Boitsov SA, Balanova SA, Shalnova SA et al. Arterial hypertension among people aged 25-64: prevalence, awareness, treatment and control. According to the research essay. Cardiovascular Therapy and Prevention. 2014;13(4):4-14 (Russian)
  2. Isayeva GS, Reznik LA, Vovchenko MM et al. Influence of group and individual training of patients on the effectiveness of control of cardiovascular risk factors. Ukrainian Cardiological Journal. 2019;26(1):61-71 (Ukrainian)
  3. Koval OA. Intensification of antihypertensive therapy in patients with uncontrolled hypertension and overweight/obesity (according to the Ukrainian study SATISFACTION). Ukrainian Cardiological Journal. 2020;27(5):34-50 (Ukrainian)
  4. Koval SM. Problems of classification and diagnosis of hypertension and stratification of the risk of its complications in the light of the European recommendations for 2018 (commentary to the recommendations). Hypertension. 2019;1(63):26-34 (Ukrainian)
  5. Lutai MI, Holikova SP. Efficacy of treatment of patients with stable coronary heart disease and concomitant hypertension: the results of a multicenter study PRESTOL. Ukrainian Cardiological Journal. 2019;26(1):19-30 (Ukrainian)
  6. Lutai MI, Lysenko HF, Holikova SP et al. TRIUMPH-3: antihypertensive therapy in Ukraine – optimization of blood pressure in focus. The use of a triple fixed combination of antihypertensive drugs in the practice of family medicine. Ukrainian Cardiological Journal. 2020;27(3):9-24 (Ukrainian)
  7. Mishchenko LA. Risk factors and socioeconomic status of patients with newly diagnosed hypertension: the results of the START II study. Ukrainian Cardiological Journal. 2019;25(6):47-58 (Ukrainian)
  8. Slashcheva TH, Radchenko HD, Sirenko UM et al. Factors associated with changes in the patient’s adherence to antihypertensive treatment. Ukrainian Cardiological Journal. 2017;5:29-39 (Ukrainian)
  9. Hafizova LS, Khamidullaeva GA. Effective long-term multicomponent antihypertensive therapy in achieving the target blood pressure in patients with resistant hypertension. Hypertension. 2018;4(60):5-11 (Russian)
  10. Alhalaiqa F, Deane K, Gray R. Hypertensive patients’ experience with adherence therapy for enhancing medication compliance: a qualitative exploration. J Clin Nurs. 2013;22(13-14):2039-2052.
  11. Bader RJK, Koprulu F, Hassan NAGM, Ali AAA, Elnour AA. Predictors of adherence to antihypertensive medication in northern United Arab Emirates. EMHJ. 2015;21(5):309-318.
  12. Black H, Elliott W, Neaton J et al. Baseline characteristics and early blood pressure control in the CONVINCE trial. Hypertension. 2001;37(1):12-18.
  13. Chobanian A, Bakris G, Black H et al. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252.
  14. Erkens J, Panneman M, Klungel O et al. Differences in antihypertensive drug persistence associated with drug class and gender: a PHARMO study. Pharmacoepidemiol Drug Saf. 2005;14(11):795-803.
  15. Gascón J, Sánchez-Ortuño M, Llor B et al. Why hypertensive patients do not comply with the treatment: results from a qualitative study. Family Practice. 2004;21(2):125–130.
  16. Hashmi S, Afridi M, Abbas K et al. Factors associated with adherence to antihypertensive treatment in Pakistan. PLoS One. 2007;2(3):e280.
  17. Haynes R, Ackloo E, Sahota N et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;2:CD000011.
  18. Holt E, Joyce C, Dornelles A et al. Sex differences in barriers to antihypertensive medication adherence: findings from the cohort study of medication adherence among older adults. J Am Geriatr Soc. 2013;61(4):558-564.
  19. Hsu C, Wang T. Secular trends in prescription patterns of single-pill combinations of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker plus a thiazide diuretic for hypertensive patients in Taiwan. Acta Cardiol Sin. 2013;29(1):49-55.
  20. Huang S, Chen Y, Zhou J et al. Use of family member-based supervision in the management of patients with hypertension in rural China. Patient Prefer Adherence. 2014;8:1035-1042.
  21. Hyre A, Krousel-Wood M, Muntner P et al. Prevalence and predictors of poor antihypertensive medication adherence in an urban health clinic setting. J Clin Hypertens (Greenwich). 2007;9(3):179-186.
  22. Krousel-Wood M, Thomas S, Muntner P et al. Medication adherence: a key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients. Curr Opin Cardiol. 2004;19:357-362.
  23. Lee G, Wang H, Liu K et al. Determinants of medication adherence to antihypertensive medications among a Chinese population using Morisky Medication Adherence Scale. PLoS One. 2013;8(4):e62775.
  24. Martin K, Roter D, Beach M et al. Physician communication behaviors and trust among black and white patients with hypertension. Med Care. 2013;51(2):151-157.
  25. Natarajan N, Putnam W, Van Aarsen K et al. Adherence to antihypertensive medications among family practice patients with diabetes mellitus and hypertension. Can Fam Physician. 2013;59(2):e93-100.
  26. Nelson M, Reid C, Ryan P et al. Self-reported adherence with medication and cardiovascular disease outcomes in the Second Australian National Blood Pressure Study (ANBP2). Med J Aust. 2006;185:487-489.
  27. Okoro R, Ngong C. Assessment of patient’s antihypertensive medication adherence level in non-comorbid hypertension in a tertiary hospital in Nigeria. Int J Pharma Bio Sci. 2012;3(2):47-54.
  28. Panjabi S, Lacey M, Bancroft T et al. Treatment adherence, clinical outcomes, and economics of triple-drug therapy in hypertensive patients. J Am Soc Hypertens. 2013;7(1):46-60.
  29. Ramli A, Ahmad N, Paraidathathu T. Medication adherence among hypertensive patients of primary health clinics in Malaysia. Patient Prefer Adherence. 2012;6:613-622.
  30. Sabate E. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.
  31. Shah N, Hirsch A, Zacker C et al. Predictors of first-fill adherence for patients with hypertension. Am J Hypertens. 2009;22(4):392-396.
  32. Vrijens B, Vincze G, Kristanto P et al. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ. 2008;336(7653):1114-1117.
  33. Youssef R, Moubarak I. Patterns and determinants of treatment compliance among hypertensive patients. East Mediterr Health J. 2002;8(4-5):579-592.
  34. Zedler B, Kakad P, Colilla S et al. Does packaging with a calendar feature improve adherence to self-administered medication for long-term use? A systematic review. Clin Ther. 2011;33(1):62-73.