The study of medication adherence in patients with arterial hypertension in the practice of a family doctor

Abstract

The treatment of arterial hypertension (AH) is one of the most significant problems of modern internal medicine. Elevated blood pressure (BP) is a major risk factor for atherosclerosis, mainly coronary heart disease and damage to
the brain vessels. Medication adherence (MA) is a complex problem in patients with chronic cardiovascular diseases, especially AH.

Aim. To study MA when treating patients with AH in a real Ukrainian out-patient practice for 8 weeks.

Materials and methods. The sample of 274 patients with AH included men and women over 18 years old with the initial level of office systolic blood pressure (SBP) of 140-179 mm Hg and diastolic blood pressure (DBP) of 99-100 mm Hg against the background of the antihypertensive therapy or without it. Initially, BP was measured at the doctor’s office (office blood pressure) in all patients who were enrolled in the study; the body mass index (BMI), as well as risk factors were calculated, and the concomitant therapy was assessed. The quality of life was determined by a visual analog scale (VAS score). Patient adherence to the drug therapy was evaluated using the Morisky Medication Adherence Scale (MMAS).

Results and discussion. To conduct the study according the MMAS test all patients were distributed in two groups with low MA (MMAS = 3 or 4, n = 181) or high MA (MMAS ≤ 2, n = 93) by the psychometric scale. The results of the MMAS test obtained were confirmed by the reliability parameter used in psychometrics (Cronbach’s Alpha ˃ 0.7). It was found at the end of the study that BP levels less than 140/90 mm Hg of 50.6 % of the Low MA group patients and 47.7 % of the High MA group patients were reached. A decrease in SBP < 140 mm Hg or a decrease in 20 mm Hg and more from the initial level, as well as a decrease in DBP < 90 mm Hg or 10 mm Hg and more was observed in 98.8% of patients in the Low MA group and in 98.4 % in the High MA group. After 8 weeks of observation, the quality of life significantly improved in both groups; however, in the Low MA group this improvement was more pronounced – more than 85 points instead of 82.8 by the VAS scores for the High MA group.

Conclusions. The effectiveness of the AH treatment and achievement in the target BP level depend on the patient’s MA. Regular visits to the family doctor’s clinic mobilize patients, and are one of the factors that increase adherence to the treatment, along with pharmaceutical care.