Analysis of the controlled essential hypertension’s pharmacotherapy in general practice

Abstract

BACKGROUND: Arterial hypertension is a common cardiovascular disease that requires constant monitoring by a doctor of drug therapy to achieve the target blood pressure level.

AIM: To analyze pharmacotherapy of essential hypertension in patients, who have achieved a controlled course of the disease.

MATERIALS AND METHODS: In this study 274 patients with controlled course of stage 2 arterial hypertension and no comorbidities were recruited. Blood pressure indicators, anthropometric data, results of laboratory and instrumental studies, the volume of drug therapy for hypertension were analyzed.

RESULTS: We analyzed 543 drug prescriptions for 274 patients with stage II hypertension. In 97 (35.3%) patients only one drug was prescribed, in 112 (40.7%) — two drugs, in 46 (16.7%) — three drugs from various pharmacological groups, among which monodrugs were in the lead: angiotensin-converting-enzyme inhibitors — 31.86%, cardioselective β-blockers — 23%, angiotensin 2 receptor blockers — 9.3%. Combined drugs were present in 18.4% of general doctors’ prescriptions. Fixed forms of combined antihypertensive drugs were taken by only 50 (18.4%) patients. To prevent cardiovascular complications of arterial hypertension, 75 (26%) patients were prescribed statins (atorvastatin or rosuvastatin) and 56 (19.5%) — antiplatelet monotherapy with Cardiomagnyl, Thrombo ACC or clopidogrel.

CONCLUSIONS: To achieve the target blood pressure level and control arterial hypertension in patients with stage II hypertension, general practitioners used all main

Keywords

essential hypertension / arterial hypertension / pharmacological therapy

References

[1] Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice Eur Heart J. 2016;37(29):2315–2381. DOI: 10.1093/eurheartj/ehw106

[2] Piepoli M.F., Hoes A.W., Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice // Eur. Heart J. 2016. Vol. 37, No. 29. P. 2315–2381. DOI: 10.1093/eurheartj/ehw106

[3] Oparil S, Acelajado MC, Bakris GL, et al. Hypertension. Nat Rev Dis Primers. 2018;4:18014. DOI: 10.1038/nrdp.2018.14

[4] Oparil S., Acelajado M.C., Bakris G.L. et al. Hypertension // Nat. Rev. Dis. Primers. 2018. Vol. 4. P. 18014. DOI: 10.1038/nrdp.2018.14

[5] Oschepkova EV. Five-year results of realization of federal target program “Prevention and treatment of arterial hypertension in Russian Federation” (2002-2006). Therapeutic Archives. 2007;79(9):25–30. (In Russ.)

[6] Ощепкова Е.В. Пятилетние итоги реализации федеральной целевой программы «Профилактика и лечение артериальной гипертонии в Российской Федерации» (2002–2006 гг.) // Терапевтический архив. 2007. Т. 79, № 9. С. 25–30.

[7] Evstifeeva SE, Gridnev VI, Oschepkova EV. 4-th School for doctors of AH register. Evaluation of treatment and prevention among patients with arterial hypertension in primary care unit (data from hypertension register). Atmosphere. Cardiologiya. 2007;4:18–20. (In Russ.)

[8] Евстифеева С.Е., Гриднев В.И., Ощепкова Е.В. 4-я Школа врачей Регистра АГ. Оценка лечебно-профилактической помощи больным артериальной гипертонией в первичном звене здравоохранения (по данным Регистра АГ) // Атмосфера. Новости кардиологии. 2007. № 4. С. 18–20.

[9] Estruch R, Ros E, Salas-Salvado J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279–1290. DOI: 10.1056/NEJMoa1200303

[10] Estruch R., Ros E., Salas-Salvado J. et al. Primary prevention of cardiovascular disease with a Mediterranean diet // N. Engl. J. Med. 2013. Vol. 368, No. 14. P. 1279–1290. DOI: 10.1056/NEJMoa1200303

[11] Rossi A, Dikareva A, Bacon SL, Daskalopoulou SS. The impact of physical activity on mortality in patients with high blood pressure: a systematic review. J Hypertens. 2012;30(7):1277–1288. DOI: 10.1097/HJH.0b013e3283544669

[12] Rossi A., Dikareva A., Bacon S.L., Daskalopoulou S.S. The impact of physical activity on mortality in patients with high blood pressure: a systematic review // J. Hypertens. 2012. Vol. 30, No. 7. P. 1277–1288. DOI: 10.1097/HJH.0b013e3283544669

[13] Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–2260. DOI: 10.1016/S0140-6736(12)61766-8

[14] Lim S.S., Vos T., Flaxman A.D. et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 // Lancet. 2012. Vol. 380, No. 9859. P. 2224–2260. DOI: 10.1016/S0140-6736(12)61766-8

[15] Chazova IE, Zhernakova YuV. Diagnosis and treatment of arterial hypertension. Guidelines. Systemic Hypertension. 2019;16(1):6–31. (In Russ.) DOI: 10.26442/2075082X.2019.1.190179

[16] Чазова И.Е., Жернакова Ю.В. Клинические рекомендации. Диагностика и лечение артериальной гипертонии // Системные гипертензии. 2019. Т. 16, № 1. С. 6–31. DOI: 10.26442/2075082X.2019.1.190179

[17] Wald DS, Law M, Morris JK, et al. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009;122(3):290–300. DOI: 10.1016/j.amjmed.2008.09.038

[18] Wald D.S., Law M., Morris J.K. et al. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials // Am. J. Med. 2009. Vol. 122, No. 3. P. 290–300. DOI: 10.1016/j.amjmed.2008.09.038

[19] Kim S, Shin DW, Yun JM, et al. Medication adherence and the risk of cardiovascular mortality and hospitalization among patients with newly prescribed antihypertensive medications. Hypertension. 2016;67(3):506–512. DOI: 10.1161/HYPERTENSIONAHA.115.06731

[20] Kim S., Shin D.W., Yun J.M. et al. Medication adherence and the risk of cardiovascular mortality and hospitalization among patients with newly prescribed antihypertensive medications // Hypertension. 2016. Vol. 67, No. 3. P. 506–512. DOI: 10.1161/HYPERTENSIONAHA.115.06731

[21] Trukhan DI, Davydov EL. Angiotensin receptor blockers II in the treatment of arterial hypertension in patients with comorbid pathology: the possibilities of candesartan. Consilium Medicum. 2017;19(10):25–32. (In Russ.) DOI: 10.26442/2075-1753_19.10.25-32

[22] Трухан Д.И., Давыдов Е.Л. Блокаторы рецепторов к ангиотензину II в лечении артериальной гипертонии у пациентов с коморбидной патологией: возможности кандесартана // Consilium Medicum. 2017. Т. 19, № 10. С. 25–32. DOI: 10.26442/2075-1753_19.10.25-32

[23] 2020 Clinical practice guidelines for chronic heart failure. Russian Journal of Cardiology. 2020;25(11):4083. (In Russ.) DOI: 10.15829/1560-4071-2020-4083

[24] Хроническая сердечная недостаточность. Клинические рекомендации 2020 // Российский кардиологический журнал. 2020. Т. 11, № 25. С. 311–374. DOI: 10.15829/1560-4071-2020-4083

[25] 2020 Clinical practice guidelines for stable coronary artery disease. Russian Journal of Cardiology. 2020;25(11):4076. (In Russ.) DOI: 10.15829/1560-4071-2020-4076

[26] Стабильная ишемическая болезнь сердца. Клинические рекомендации 2020 // Российский кардиологический журнал. 2020. Т. 25, № 11. С. 201–247. DOI: 10.15829/29/1560-4071-2020-4076

[27] Clinical recommendations. Chronic kidney disease (CKD). Nephrology (Saint Petersburg). 2021;25(5):10–82. (In Russ.)

[28] Хроническая болезнь почек. Клинические рекомендации // Нефрология. 2021. Т. 25, № 5. С. 10–82.

[29] ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD Russian Journal of Cardiology. 2020;25(4):101–161. (In Russ.) DOI: 10.15829/1560-4071-2020-3839

[30] Рекомендации ЕSC/EASD по сахарному диабету, предиабету и сердечно-сосудистым заболеваниям // Российский кардиологический журнал. 2020. Т. 25, № 4. С. 101–161. DOI: 10.15829/1560-4071-2020-3839

[31] Glezer MG. Evaluation of antihypertensive efficacy and patient adherence to treatment with the new formulation perindopril arginine (orally disintegrating tablet) in general clinical practice: OPTIMUM program. Kardiologiia. 2016;56(4):36–41. (In Russ.) DOI: 10.18565/cardio.2016.4.36-41

[32] Глезер М.Г. Оценка антигипертензивной эффективности и приверженности пациентов к лечению при использовании новой лекарственной формы периндоприла аргинина в общей клинической практике: программа ОПТИМУМ // Кардиология. 2016. Т. 56, № 4. С. 36–41. DOI: 10.18565/cardio.2016.4.36-41

[33] Kryuchkova ON, Itskova EA, Lutay YuA, et al. Achievement of arterial hypertension control via application of perindopril arginine and amlodipine combination. Russian Journal of Cardiology. 2015;128(12):102–106. (In Russ.) DOI: 10.15829/1560-4071-2015-12-102-106

[34] Крючкова О.Н., Ицкова Е.А., Лутай Ю.А. и др. Достижение контроля артериальной гипертензии при применении фиксированной комбинации периндоприла аргинина и амлодипина // Российский кардиологический журнал. 2015. Т. 128, № 12. С. 102–106. DOI: 10.15829/1560-4071-2015-12-102-106

[35] Nebieridze DV. Topical issues of beta-blockers use in various clinical situations. Medical Council. 2018;(12):12–17. (In Russ.) DOI: 10.21518/2079-701X-2018-12-12-17

[36] Небиеридзе Д.В. Актуальные вопросы применения бета-адреноблокаторов в различных клинических ситуациях // Медицинский совет. 2018. № 12. С. 12–17. DOI: 10.21518/2079-701X-2018-12-12-17

Funding

Правительство РФThe Government of the Russian FederationThe Government of the Russian Federation(АААА-А19-11911190068-2)

RIGHTS & PERMISSIONS

Eco-Vector