The study of medication adherence in patients with arterial hypertension in the practice of a family doctor
Keywords:arterial hypertension, medication adherence, primary care, physician-patient communication, systolic blood pressure, diastolic blood pressure, Morisky Medication Adherence Scale
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.
Forouzanfar, M. H., Liu, P., Roth, G. A., Ng, M., Biryukov, S., Marczak, L, Ali, R. (2017). Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. Journal of the American Medical Association, 317 (2), 165–182. doi: https://doi.org/10.1001/jama.2016.19043.
Tseluiko, V. I., Avilova Ya. M., Alchinskii, I. V., Antipenko, I. D. (2018). Realii lecheniya arterialnoy gipertenzii v Ukraine: rezultatyi kogortnogo issledovaniya SISTEMA-2. Ukrainskyi kardiolohichnyi zhurnal, 1, 13–20. Available at: http://www.ucardioj.com.ua/index.php/UJC/article/view/45.
Jankowska-Polańska, B., Uchmanowicz, I., Dudek, K., Mazur, G. (2016). Relationship between patients’ knowledge and medication adherence among patients with hypertension. Patient preference and adherence, 10, 2437–47. doi: https://doi.org/10.2147/PPA.S117269.
DiMatteo, M. (2004). Variations in Patients’ Adherence to Medical Recommendations: A Quantitative Review of 50 Years of Research. Medical Care, 42 (3), 200–209. doi:https://doi.org/10.1097/01.mlr.0000114908.90348.f9.
Sabaté, E. (2003). Adherence to long-term therapies: evidence for action. Geneva, World Health Organization. Available at: https://apps.who.int/iris/handle/10665/42682.
World Health Organization. (2007). Prevention of cardiovascular disease: Guidelines for assessment and management of cardiovascular risk. Geneva, WHO. Available at: https://apps.who.int/iris/handle/10665/43685.
Marcum, Z. A., Zheng, Y., Perera, S., Strotmeyer, E., Newman, A. B., Simonsick, E. M. et al. (2013). Prevalence and correlates of selfreported
medication non-adherence among older adults with coronary heart disease, diabetes mellitus, and/or hypertension. Research in Social and Administrative Pharmacy, 9 (6), 817–827. doi: https://doi.org/10.1016/j.sapharm.2012.12.002.
Abegaz, T. M., Shehab, A., Gebreyohannes, E. A., Bhagavathula, A. S., Elnour, A. A. (2017). Nonadherence to antihypertensive drugs: a systematic review and meta-analysis. Medicine, 96 (4), e5641. DOI: https://doi.org/10.1097/MD.0000000000005641
Paczkowska, A., Kopciuch, D., Nowakowska, E., Hoffmann, K., Bryl, W. (2016). Compliance among adolescents with arterial hypertension.
Advances in Clinical and Experimental Medicine, 25 (3), 441–448. doi: https://doi.org/10.17219/acem/33838.
Morisky, D. E., Ang, A., Krousel‐Wood, M., Ward, H. J. (2008). Predictive validity of a medication adherence measure in an outpatient
setting. The Journal of Clinical Hypertension, 10 (5), 348–354. doi: https://doi.org/10.1111/j.1751-7176.2008.07572.x.
Copyright (c) 2021 National University of Pharmacy
This work is licensed under a Creative Commons Attribution 4.0 International License.Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).