CHANGE OF HYPERTENSION TREATMENT SCHEME IN OUTPATIENT CARE AT SPECIALIZED CARDIOLOGIC INSTITUTION, AND FACTORS ASSOCIATED WITH THE CHANGE OF ANTIHYPERTENSION THERAPY

Compliance to the recommended treatment strategy is a significant component of
adherence to antihypertension therapy (AT) that is associated with treatment
efficacy and economical benefits.
Aim. To study the scheme of drug therapy in patients with arterial hypertension (AH),
first time requested cardiological assessment, during 6 month since the moment of
the admittance with the assessment of factors associated with the treatment
scheme.
Material and methods. The study done in 2 stages. First stage was focused on
the selection of patients who first time presented at one of the district
cardiodispensaries in Moscow (CD) among those with AH, from January to
December. The expert charts were completed according to the source documents
(n=1766). Second stage was focused on the phone survey in 6 months after
primary admittance (n=1419).
Results. Analysis of AT compliance showed that the patients in specialized
cardiological institution have low level of adherence to physicians' recommendations
on the treatment scheme; in 6 months only 25,1% continued taking recommended
drugs. More than a half (52,4%) of those who changed treatment scheme, done in
on their own, without physician assessment. One of the reasons was distrust to physician's recommendations (48,6%). Probability of the change of cardiologist-recommended AT was significantly related to the factors as an opportunity to get the drugs by discount rate (as incentives) (OR 2,4), coronary heart disease (OR 2,0), hypertension for less than 5 years (OR 1,5), hypertensive crises (OR 1,9), intake of three and more cardiovascular drugs (OR 2,4) and the absence of drug combinations in the scheme (OR 1,4).
Conclusion. Patients of the specialized cardiological institution have low level of physician recommendations adherence by the 6-month scheme of treatment, they correct their treatment themselves, and the motivation for the scheme change their name distrust to the treating physician.

1. Kolandaivelu К, Leiden BB, O'Gara PT, et al. Non-adherence to cardiovascular medications. European Heart Journal 2014; 35: 3267-76.

2. Nelson MR, Reid CM, 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; 185:487-8.

3. Chowdhury R, Khan H, Heydon E, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J. 2013; 34(38): 2940-8.

4. Sokol MC, McGuigan KA, Verbrugge RR, et al. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005; 43(6): 521-30.

5. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24(1): 67-74.

6. Corrao G, Zambon A, Parodi A, et al. Discontinuation of and changes in drug therapy for hypertension among newly-treated patients: a population-based study in Italy. J Hypertens. 2008; 26(4): 819-24.

7. Burke ТА, Sturkenboom MC, Lu SE, et al. Discontinuation of antihypertensive drugs among newly diagnosed hypertensive patients in UK general practice. J Hypertens. 2006; 24(6):1193-200.

8. Wong MC, Tarn WW, Cheung CS, et al. Initial antihypertensive prescription and switching: a 5 year cohort study from 250,851 patients. PLoS One. 2013; 8(1): e53625.

9. Chou CC, Lee MS, Ke CH, et al. Factors influencing the switch inthe use of antihypertensive medications. Int J Clin Pract. 2005; 59(1): 85-91.

10. Mazzaglia G, Mantovani LG, Sturkenboom MC, et al. Patterns of persistence with antihypertensive medications in newly diagnosed hypertensive patients in Italy: a retrospective cohort study in primary care. J Hypertens. 2005; 23(11): 2093-100.

11. LihachevSA, Lushhik AV. Arterial hypertension and adherence to antihypertensive therapy according to population research. Bjulleten' medicinskih internet-konferencij (ISSN 2224-6150) 2014; 4(2): 103. Russian (Лихачев С.А., Лущик А.В. Артериальная гипертензия и приверженность антигипертензивной терапии по данным популяционного исследования. Бюллетень медицинских Интернет конференций (ISSN 2224 6150) 2014; Том4, №2:103).

12. Olejnikov VJe, Eliseeva IV, Tomashevskaja JuA, et al. Efficiency of antihypertensive therapy at elderly patients and the analysis of adherence to treatment. Racional'naja Farmakoterapija v Kardiologii 2014; 10(4): 391-6. Russian (Олейников В.Э., Елисеева И.В., Томашевская Ю.А. и др. Эффективность антигипертензивной терапии у пожилых пациентов и анализ приверженности лечению. Рациональная Фармакотерапия в Кардиологии 2014; 10(4): 391-6).

13. Degli Esposti E, Surani A, DiMartino M, et al. Long term persistence with antihypertensive drugs in new patients.J Hum Hypertens. 2002; 16:439-44.

14. Patel BV, Remigio-Baker RA, Thiebaud P, et al. Improved persistence and adherence to diuretic fixed-dose combination therapy compared to diuretic monotherapy. BMC Family Practice. 2008; 9: 61.

15. Konobeeva EV, Shvarc JuG, Korsunova EN, et al. Possibilities of increase the conscious motivation of patients cardiac profile. Using standard visual recommendations. Fundamental'nye issledovanija 2013; 9,part 1: 58-61. Russian (Конобеева Е.В., Шварц Ю. Г., Корсунова Е. Н. и др. Возможности повышения осознанной мотивации пациентов кардиологического профиля. Использование стандартных наглядных рекомендаций. Фундаментальные исследования 2013; 9, часть 1:58-61).