FACTORS INFLUENCING ON ADHERENCE TO ANTIHYPERTENSIVE THERAPY AT PATIENTS WITH ARTERIAL HYPERTENSION IN EAST KAZAKHSTAN
Aim of research – to analyse influence of social-economical, clinical and pharmaco-epidemiological factors to patients’s compliance on the treatment in population of East Kazakhstan.
Materials and methods: Study design – cross-sectional study. The study included 2346 patients with arterial hypertension aged 25 to 80 years, including 1281 men (54,6%) and 1065 women (45,4%). The average age is 55,2 ± 1,1 years.
Carried out estimation of compliance to medical therapy at patients with arterial hypertension. Depending on the degree of compliance, estimated patients divided on three groups: «no compliance»; «partial»; «full». As factors influencing on compliance, considered: gender; age; economic status; the degree of BP increase (including the option of isolated systolic hypertension); the presence of complications from the heart and blood vessels; presence of concomitant diseases (IHD, diabetes mellitus); a variant of drug therapy.
Results: Complete compliance to drug therapy defined in 41,1% of cases, lack of commitment - in 26,9% of cases. The lowest compliance was determined in young people (25-40 years old) - the differences with the mean for the whole group were significant (for complete compliance in men, p=0.003).
A high level of compliance was determined in patients with AH III degree, it significantly exceeded the corresponding index in all other groups in terms of the degree of BP increase. In the presence of concomitant IHD, diabetes, and their combinations, full compliance was observed significantly more often than in the absence (IHD - p <0,001, diabetes - p = 0,003). A high indicator of total compliance defined in people who underwent myocardial infarction. Differences with patients who did not have a history of AH complications were significant (p<0,001). A significant excess was revealed by the indicator of total compliance in individuals with a high and satisfactory economic status over a subgroup with a low (p = 0,002, p = 0,001). The highest frequency of complete compliance was determined with the use of fixed combinations of antihypertensive drugs. Then sequentially monotherapy beta-blockers, calcium antagonists, a combination of separate dosage forms, AIR, angiotensin receptor blockers. Lower rates of complete compliance found in ACE inhibitors, diuretics, drugs of other pharmacological groups. The role of the variant of drug therapy in the formation of compliance is most pronounced in arterial hypertension III st. and ISAH.
Conclusion:
Extent of increase blood pressure was the major factor defining commitment to medicamentous pharmacotherapy of arterial hypertension. The role of economic factor and the accompanied diseases was moderate.
The greatest influence on compliance provided by the option of ongoing medical therapy.
The best results obtained with the use of fixed combinations of drugs.
Aigerim Mussina, http://orcid.org/0000-0002-0114-5397
Raikhan Tuleutayeva, http://orcid.org/0000-0001-1312-1965
Pharmacology and evidence-based medicine department, Semey State Medical University, Semey, Kazakhstan
1. Abegaz T.M., Shehab A., Gebreyohannes E.A., Bhagavathula A.S., Elnour A.A. Noncompliance to antihypertensive drugs: A systematic review and meta-analysis // Medicine (Baltimore). 2017 Jan;96(4):e5641.
2. Arshad A.R. Frequency of Poor Compliance to Antihypertensive Treatment and an Analysis of Clinico-demographic Correlates // J Coll Physicians Surg Pak. 2015 Dec;25(12):911-3.
3. Baggarly S.A., Kemp R.J., Wang X., Magoun A.D. Factors associated with medication compliance and persistence of treatment for hypertension in a Medicaid population // Res Social Adm Pharm. 2014 Nov-Dec;10(6):e99-112.
4. Bautista L.E., Vera-Cala L.M., Colombo C., Smith P. Symptoms of depression and anxiety and compliance to antihypertensive medication // Am J Hypertens. 2012 Apr;25(4):505-11.
5. Calderón-Larrañaga A., Diaz E., Poblador-Plou B., Gimeno-Feliu L.A., Abad-Díez J.M., Prados-Torres A. Non-compliance to antihypertensive medication: The role of mental and physical comorbidity // Int J Cardiol. 2016 Mar 15;207:310-6.
6. Cho S.J., Kim J. Factors associated with noncompliance to antihypertensive medication // Nurs Health Sci. 2014 Dec;16(4):461-7.
7. Cooper L.A. A 41-year-old African American man with poorly controlled hypertension: review of patient and physician factors related to hypertension treatment compliance // JAMA. 2009 Mar 25;301(12):1260-72.
8. Doroszko A., Janus A., Szahidewicz-Krupska E., Mazur G., Derkacz A. Resistant Hypertension // Adv Clin Exp Med. 2016 Jan-Feb;25(1):173-83.
9. Hsu C.I., Hsiao F.Y., Wu F.L., Shen L.J. Compliance and medication utilisation patterns of fixed-dose and free combination of angiotensin receptor blocker/thiazide diuretics among newly diagnosed hypertensive patients: a population-based cohort study // Int J Clin Pract. 2015 Jul;69(7):729-37.
10. Khanam M.A., Lindeboom W., Koehlmoos T.L., Alam D.S., Niessen L., Milton A.H. Hypertension: compliance to treatment in rural Bangladesh - findings from a population-based study // Glob Health Action. 2014 Oct 20;7:25028.
11. Lopatin Iu.M. How to increase the compliance to treatment of patients with arterial hypertension and dyslipidemia: focus on fixed combination of amlodipine and atorvastatin // Kardiologiia (Moscow). 2010;50(7):83-90.
12. Mazza A., Sacco A.P., Townsend D.M., Bregola G., Contatto E., Cappello I., Schiavon L., Ramazzina E., Rubello D. Cost-benefit effectiveness of angiotensin-II receptor blockers in patients with uncomplicated hypertension: A comparative analysis // Biomed Pharmacother. 2017 Apr 14;90:665-669.
13. Mollaoğlu M., Solmaz G., Mollaoğlu M. Compliance to therapy and quality of life in hypertensive patients // Acta Clin Croat. 2015 Dec;54(4):438-44.
14. Peacock E., Krousel-Wood M. Compliance to Antihypertensive Therapy // Med Clin North Am. 2017 Jan;101(1):229-245.
15. Ritchey M., Chang A., Powers C., Loustalot F., Schieb L., Ketcham M., Durthaler J., Hong Y. Vital Signs: Disparities in Antihypertensive Medication Noncompliance Among Medicare Part D Beneficiaries - United States, 2014. MMWR Morb Mortal Wkly Rep. 2016. Sep 16;65(36):967-76.
16. Sarkar T., Singh N.P. Epidemiology and Genetics of Hypertension // J Assoc Physicians India. 2015 Sep;63(9):61-98.
17. Sonawane Deshmukh K.B., Qian J., Garza K.B., Wright B.M., Zeng P., Ganduglia Cazaban C.M., Hansen R.A. Achieving Compliance After First-Line Antihypertensive Treatment: Should Fixed-Dose Combinations Receive Priority? //J Clin Hypertens (Greenwich). 2016 Sep;18(9):934-41.
18. Stiefelhagen P. First check compliance // MMW Fortschr Med. 2016 Jun 9; 158 (11) : 24.
19. Tedla Y.G., Bautista L.E. Factors associated with false-positive self-reported compliance to antihypertensive drugs // J Hum Hypertens. 2017 May;31(5):320-326.
20. Vrijens B., Antoniou S., Burnier M., de la Sierra A., Volpe M. Current Situation of Medication Compliance in Hypertension // Front Pharmacol. 2017 Mar 1;8:100.
21. Yassine M., Al-Hajje A., Awada S., Rachidi S., Zein S., Bawab W., Bou Zeid M., El Hajj M., Salameh P. Evaluation of medication compliance in Lebanese hypertensive patients // J Epidemiol Glob Health. 2016 Sep;6(3):157-67
Bibliography link
Mussina A.Ye., Tuleutayeva R.Ye. Factors influencing on adherence to antihypertensive therapy at patients with arterial hypertension in East Kazakhstan. Nauka i Zdravookhranenie [Science & Healthcare]. 2017, 5, pp. 42-54.