Antihypertensive therapy and medication adherence in patients with uncontrolled arterial hypertension

Aim. To evaluate the antihypertensive therapy and adherence to treatment in patients with uncontrolled arterial hypertension.

Materials and Мethods. The study included 297 patients hospitalized at the E.I. Chazov National Medical Research Center of Cardiology over the period from September 2019 to March 2022. Patients were spread into two groups depending on the increase in the frequency of BP: group 1 (n=149) – increase in BP above 140/90 mm Hg 1 or more per week while taking antihypertensive therapy with clinical manifestations, and group 2 (n=148) – increase in blood pressure more than 140/90 mm Hg less than 1 per week while taking antihypertensive therapy clinical manifestations. Antihypertensive therapy and medication adherence were assessed at hospital discharge and after 12 months.

Results. Initially, the number of antihypertensive drugs was greater in patients with group 1 versus the patients with group 2 (p<0,001). The frequency of taking antihypertensive therapy initially and after 12 months was greater in group 1 (p<0,001). After 12 months, the number of antihypertensive drugs decreased in the group 1, and remained the same in group 2. When comparing the different classes of antihypertensive drugs, all classes, except angiotensin-converting enzyme inhibitors were most frequently prescribed in group 1 (p<0,05). After 12 months, a lower level of adherence was observed in group 1 patients compared to group 2 (6 [5-8] points vs. 8 [6-9] points) (p<0,001), as evidenced in the reduced intake of different classes of antihypertensive therapy.

Conclusion. Uncontrolled arterial hypertension is a release of hypertension associated with more antihypertensive medications to be prescribed and adherence to be monitored more closely.

1. Vaduganathan M, Mensah GA, Turco JV, Fuster V, Roth GA. The Global Burden of Cardiovascular Diseases and Risk. J Am Coll Cardiol 2022;80:2361–71. https://doi.org/10.1016/j.jacc.2022.11.005

2. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021;42:3227–337. https://doi.org/10.1093/eurheartj/ehab484

3. Bellows BK, Ruiz-Negrón N, Bibbins-Domingo K, King JB, Pletcher MJ, Moran AE, et al. Clinic-Based Strategies to Reach United States Million Hearts 2022 Blood Pressure Control Goals. Circ Cardiovasc Qual Outcomes 2019;12:1–10. https://doi.org/10.1161/CIRCOUTCOMES.118.005624

4. Chazova IE, Zhernakova YuV, Oshepkova EV, Shalnova SA, Yarovaya EB, Kondary AO et al. Prevalence of Cardiovascular Risk Factors in Russian Population of Patients With Arterial Hypertension. Kardiologiia 2014;54(10):4-12. (In Russ.)]. EDN SXZGCP, https://doi.org/10.18565/cardio.2014.10.4-12

5. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Pr. Hypertension 2018;71:13–115. https://doi.org/10.1161/HYP.0000000000000065

6. Kobalava ZD, Konradi AO, Nedogoda SV, Shlyakhto EV, Arutyunov GP, Baranova EI et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):3786. (In Russ.)]. https://doi.org/10.15829/1560-4071-2020-3-3786

7. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348-54. https://doi.org/10.1111/j.1751-7176.2008.07572.x

8. Vuylsteke A, Vincent J-L, Payen de La Garanderie D, Anderson FA, Emery L, Wyman A, et al. Characteristics, practice patterns, and outcomes in patients with acute hypertension: European registry for Studying the Treatment of Acute hyperTension (Euro-STAT). Crit Care 2011;15:R271. https://doi.org/10.1186/cc10551

9. Burnier M, Egan BM. Adherence in Hypertension. Circ Res 2019;124:1124–40. https://doi.org/10.1161/CIRCRESAHA.118.313220

10. Wallbach M, Lach N, Stock J, Hiller H, Mavropoulou E, Chavanon ML, et al. Direct assessment of adherence and drug interactions in patients with hypertensive crisis — A cross-sectional study in the Emergency Department. J Clin Hypertens 2019;21:55–63. https://doi.org/10.1111/jch.13448

11. Bloom BS. Continuation of initial antihypertensive medication after 1 year of therapy. Clin Ther 1998;20:671–81. https://doi.org/10.1016/S0149-2918(98)80130-6

12. Yousuf FS, Khan MAA, Bibi R, Arif A, Arshad A, Almas A. Medication Adherence in Patients With Uncontrolled Hypertension; Hypertensive Crisis Presenting to a Hospital Setting in Karachi, Pakistan. Cureus 2023 Jan 20;15(1):e33995. https://doi.org/10.7759/cureus.33995

13. Sim JJ, Bhandari SK, Shi J, Reynolds K, Calhoun DA, Kalantar-Zadeh K, et al. Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension. Kidney Int 2015;88:622–32. https://doi.org/10.1038/ki.2015.142

14. Choudhry NK, Kronish IM, Vongpatanasin W, Ferdinand KC, Pavlik VN, Egan BM, et al. Medication Adherence and Blood Pressure Control: A Scientific Statement From the American Heart Association. Hypertension 2022;79:E1–14. https://doi.org/10.1161/HYP.0000000000000203

15. Efremova E, Shutov A, Suvorova S, Tolstyga M, Vydrina S, Troshina I, et al. Adherence to lifestyle therapy and drug therapy in patients with arterial hypertension and comorbidity. J Hypertens 2019;37:e251. https://doi.org/10.1097/01.hjh.0000573212.41860.01

16. Gulayin PE, Beratarrechea A, Poggio R, Gibbons L, Nejamis A, Santero M, et al. Blood Pressure Association with the 8-Item Morisky Medication Adherence Scale in Hypertensive Adults from Low-Resource Primary Care Settings: Results from a Prospective Cohort Nested within a Randomised Controlled Trial. High Blood Press Cardiovasc Prev 2023 May;30(3):281-288:Online ahead of print. https://doi.org/10.1007/s40292-023-00580-7