cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2017.7.10004cardio-6Research ArticleАРТЕРИАЛЬНАЯ ГИПЕРТОНИЯARTERIAL HYPERTENSIONПриверженность к терапии в амбулаторных условиях: возможность выявления и оценка эффективности терапииAdherence to Therapy in the Outpatient Setting: the Ability to Identify and Assess the Effectiveness of TherapyФофановаТ. В.FofanovaT. V.t.fofanova@yandex.ruАгеевФ. Т.AgeevF. T.noemail@neicon.ruСмирноваМ. Д.SmirnovaM. D.noemail@neicon.ruДеевА. Д.DeevA. D.t.fofanova@yandex.ruИнститут клинической кардиологии им. А. Л. Мясникова ФГБУ «Российский кардиологический научно-производственный комплекс» Минздрава РФРоссияinstitute of Cardiology of Russian Cardiology Scientific and Production ComplexRussian FederationФГБУ «Государственный научно-исследовательский центр профилактической медицины» Минздрава РФРоссияState Institution National Research Center for Preventive MedicineRussian Federation2017171120185773542Copyright © Kardiomag, 20182018KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/6

Цель исследования. Оценка приверженности к терапии и определение роли различных факторов, влияющих на приверженность пациентов к лечению в амбулаторных условиях, а также оценка клинической эффективности антагониста кальция фелодипина. Материалы и методы. Обследовали 5474 пациентов (мужчины и женщины) старше 18 лет с исходным уровнем офисного систолического артериального давления (АД) 140-179 мм рт. ст. и диастолического АД до 100 мм рт. ст. на фоне гипотензивной терапии или без нее, побывавших на приеме у участкового терапевта. Всем больным кроме общего клинического обследования, включавшего офисное измерение АД, проводили оценку ФР, сопутствующей терапии. Все больные самостоятельно оценивали свое самочувствие с использованием визуальной аналоговой шкалы (ВАШ), приверженность пациента к терапии оценивали с использованием теста Мориски-Грина. Обязательно регистрировали получение пациентом антигипертензивных препаратов в рамках системы дополнительного лекарственного обеспечения (ДЛО). Результаты. Среди амбулаторных больных артериальной гипертонией (АГ) и ишемической болезнью сердца (ИБС), обследованных в поликлиниках Москвы, более 60% имеют низкую приверженность к приему назначенных препаратов. С высокой приверженностью к лечению ассоциируются такие факторы, как осложненное течение АГ при ее сочетании с ИБС, или сахарный диабет (СД), а также использование в терапии ингибиторов ангиотензинпревращающего фермента, антагонистов кальция, блокаторов рецепторов ангиотензина II. С низкой приверженностью к лечению достоверно ассоциированы мужской пол, пожилой возраст, наличие ФР развития сердечно-сосудистых осложнений и длительный анамнез АГ Наличие препаратов в списке ДЛО при однофакторном анализе ассоциировано с высокой приверженностью к терапии. Включение в анализ таких дополнительных факторов, как ИБС, СД и наличие домашнего тонометра (многофакторный анализ), делает вклад ДЛО в высокую приверженность незначимым и недостоверным. Применение фелодипина в амбулаторных условиях позволяет не только достигнуть выраженного гипотензивного эффекта у больных АГ как в период подбора дозы, так и при последующем наблюдении, но и достоверно улучшить приверженность в группе пациентов с низкой приверженностью к лечению. Заключение. Необходимо регулярно проводить оценку возможной низкой приверженности к терапии с целью ее повышения при длительном амбулаторном наблюдении

Aim. To assess adherence of patients to antihypertensive therapy, to determine the role of various factors affecting adherence to treatment by outpatients, and to assess clinical efficacy of a calcium antagonist felodipine. Material and methods. We examined 5 474 women and men aged >18 years who at visit to a local internist had office systolic arterial pressure (AP) 140-179 and diastolic AP up to 100 mm Hg both on and without hypotensive therapy. Examination included registration of risk factors and concomitant therapy. All patients self-assessed their state of heath using visual analog scale (VAS). Adherence to therapy was evaluated by the Morisky-Green test. Obtaining by a patient of antihypertensive drugs in the framework of the Programme for Supplementary Pharmaceutical Provision (SPP) was necessarily registered. Results. Among examined ambulatory patients with arterial hypertension (AH) and ischemic heart disease (IHD) more than 60% had low adherence to prescribed medications. Such factors as complicated AH course when AH was combined with IHD or diabetes (D), use of angiotensin converting enzyme inhibitors, calcium antagonists, and angiotensin receptor blockers were associated with high adherence to treatment. Male sex, elderly age, presence of risk factors of cardiovascular complications, and long history of AH were associated with low adherence to therapy. Presence of prescribed drugs in the SSP list was associated with high adherence but multifactorial analysis with inclusion of IHD, D, availability of a tonometer at home made contribution of SSP in high adherence insignificant. The use of felodipine allowed not only to achieve pronounced hypotensive effect in patients with AH but also to improve initially low adherence. Conclusion. During long-term observation of outpatients, it is necessary to regularly assess possibly low adherence to therapy with the aim of its improvement.

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The authors declare that there are no conflicts of interest present.