Is It  Possible to Improve  the Adherence to Treatment  of  Hypertension  and  Dyslipidemia in  Patients  Without  Clinical Manifestations of Atherosclerosis?

Сарычева, А. А.; Небиеридзе, Д. В.; Kamyshova, T. V.

doi:10.20996/1819-6446-2017-13-5-602-608

Cited by 4 publications

(8 citation statements)

References 5 publications

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“…Interventions to increase adherence were mainly either patient education (in various forms) in 6 studies [12, 13, 19–23] or optimization of the drug administration regimen in 11 studies [11–13, 15–19, 32, 33, 35, 36], among which 9 used a fixed-dose combination of drugs [11, 15, 16, 18, 19, 32, 33, 35, 36]. One study gave patients an electronic version of the SCORE scale, with the physician showing the patient how their risk would be reduced if they stopped smoking, controlled their BP and reduced their cholesterol [14]. In two studies [31, 37] patients were trained in home BP monitoring, intended to increase adherence.…”

Section: Resultsmentioning

confidence: 99%

Adherence to antihypertensive medication in Russia: a scoping review of studies on levels, determinants and intervention strategies published between 2000 and 2017

et al. 2019

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Background Arterial hypertension (HT) is common in the Russian adult population, with half of affected individuals inadequately controlled. Low adherence to medication seems likely to be a factor. We report a scoping review of studies on adherence to antihypertensive therapy (AHT) in Russia to determine the extent of research undertaken, the frequency of adherence among adults diagnosed with HT, methodologies used in the studies, and their ability to describe determinants of adherence. Methods A scoping review of published studies that have assessed adherence to AHT in Russian HT patients searched the main Russian and international electronic databases eLIBRARY.ru, Russian Medicine, Embase, MEDLINE for full-text reports published in the Russian language between 2000 and 2017. The last search was on November 28, 2017. Among 520 reports identified, 31 were included in the review. Results Eighteen studies assessed adherence using the 4-item Morisky Medication Adherence Scale (MMAS-4); others used bespoke questionnaires or pill counts. 25 studies assessed levels of adherence, 11 examined its determinants, and 18 examined intervention strategies. The proportion of “adherent” patients varied from 11 to 44% using the MMAS-4, from 23 to 74% when using bespoke questionnaires, and from 5 to 43% when using pill counts. Adherence was associated with sociodemographic factors, access to free drugs provided through the Medicine Assistance Scheme (MAS), use of home blood pressure (BP) monitoring, anxiety, and comorbidity. There was no evidence that adherence was associated with income or physical activity. Evidence of an association between MAS, grade of HT, or experience of hypertensive crisis was inconclusive. Various methods to improve adherence were studied including patient education (improved from 1.8 to 3.9 points, p = 0.0002 or 2.80 to 3.79 points, p < 0.0001 measured by the MMAS-4), telephone reminders (p < 0.0001), training in home BP monitoring (p < 0.05), and use of fixed-dose combinations (p < 0.05). Conclusions The main determinants of adherence to AHT are sociodemographic characteristics, the severity of HT, and presence of comorbidity. Patient education and use of fixed-dose combinations of drugs were identified as most important for improving adherence. Most studies assessing adherence use self-reported methods so there is a need for greater use of objective methods. Trial registration This scoping review has not been registered.

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Section: Resultsmentioning

confidence: 99%

Adherence to antihypertensive medication in Russia: a scoping review of studies on levels, determinants and intervention strategies published between 2000 and 2017

et al. 2019

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“…Применение электронной версии шкалы SCORE с демонстрацией возможностей по снижению сердечнососудистого риска в результате коррекции АД, апробированное в исследовании [23], также может служить хорошим инструментом для практического врача, позволяющим мотивировать пациентов к регулярному приему антигипертензивных препаратов.…”

Section: Discussionunclassified

“…Adherence to Antihypertensive Therapy Приверженность к антигипертензивной терапии [7,8,11,[16][17][18][20][21][22]. В одном исследовании применяли мотивационную технологию: пациентам демонстрировали электронную версию шкалы SCORE, при этом врач показывал пациенту возможность снижения сердечно-сосудистого риска при выполнении рекомендаций по отказу от курения, контролю АД и снижению уровня холестерина [23]. В двух исследованиях [24,25] пациенты обучались мониторингу АД в домашних условиях.…”

Section: материал и методыunclassified

“…1). Демонстрация электронной версии шкалы SCORE позволяла достичь более высокой приверженности в основной группе, чем в контрольной группе, с показателем среднего балла по шкале МГ-4 через 6 мес 2,75 и 1,88 балла, соответственно (р<0,001), а через 12 мес 2,14 и 1,27 балла, соответственно (р<0,001) [23].…”

Section: эффективность вмешательства по данным рандомизированных исслunclassified

“…субъективные методики, в том числе, разработанные самими авторами, сведения о тестировании или валидации которых не приводятся. Численность пациентов в группах вмешательства и контроля могла различаться [25], в некоторые исследования включали только неприверженных пациентов [9,10], в двух рандомизированных не слепых контролируемых исследованиях не сообщались исходные показатели приверженности (неполное представление данных) [23,25]. Единственный объективный метод, используемый для оценки приверженности, был косвенным, и заключался в подсчете таблеток [7,21,22,24].…”

Section: ограниченияunclassified

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Adherence to Antihypertensive Therapy: A Systematic Review of Russian Prospective Studies from 2000 to 2019

Bochkareva¹,

Butina²,

Kim³

et al. 2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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Russia belongs to countries with a high prevalence of arterial hypertension (AH), which is the main cause of premature death in the Russian population. The level of blood pressure (BP) is controlled in less than a third of patients, which may be due to poor adherence to medical recommendations and irregular medication. The manuscript provides a review of studies evaluating the effectiveness of measures to improve adherence to antihypertensive therapy (AHT).Aim. To prepare a systematic review of Russian studies to assess the effectiveness of measures to increase adherence to AHT, to determine/describe the main directions of the intervention and the methodological level.Material and methods. The search for full-text articles on adherence to AHT published in Russian in the period from 2000 to 2019 was carried out in the main Russian and international electronic databases eLIBRARY.ru, Embase, Russian Medicine, MEDLINE. Of the 563 publications found, 20 were included in the review.Results. In 14 studies, adherence was assessed using the 4-item Morisky Medication Adherence Scale (MMAS-4), other studies used bespoke questionnaires or pill counts. Two studies examined factors associated with adherence. The observation period was up 6 weeks to 12 months, the number of participants is 30-2435 people. A higher adherence was noted in women, people over 50 years old, with higher education, working, with concomitant diabetes mellitus and a history of myocardial infarction. Patient education was effective interventions to improve adherence (in particular, in studies, improvement on the MMAS-4 from 1.8 to 3.9 points, p=0.0002 or from 2.80 to 3.79 points, p<0.0001), telephone reminders (p<0.0001), training in self-measurement of blood pressure (p<0.05) and fixed combinations of drugs (p<0.05).Conclusion. The most effective ways to improve adherence are patient education and the use of drugs fixed combinations. In most studies, subjective methods of adherence assessing were used.

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The role of non-drug methods of increasing adherence to the treatment of patients with arterial hypertension in a polyclinic

Simenyura

Sizova

2022

Medicinskij sovet

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Introduction. Arterial hypertension (AH) is one of the important high-risk factors for the development of heart diseases, but its diagnosis and treatment does not require high technologies and substantial costs. However, the asymptomatic course of AH combined with a low level of medical literacy contributes to low adherence to treatment.Aim. To study the indirect impact of remote blood pressure monitoring (RBPM), the introduction of educational materials (EMs) in comparison with self-monitoring of blood pressure (SMBP) on adherence of patients with AH to outpatient treatment.Materials and methods. 60 subjects with an established fact of partial or complete refusal to use antihypertensive therapy were enrolled in the study and randomized into four equal and comparable groups: 1 – SMBP, 2 – RBPM, 3 – SMBP + EMs, 4 – RBPM + EMs. The impact of using RBPM was assessed by comparing blood pressure values in groups 1 and 2; the impact of EM – by comparing the results of questionnaire surveys in groups 1 and 2 and groups 3 and 4.Results and discussion. Additional training of patients with AH contributed to a twofold increase in adherence in using SCAD and RBPM. The average systolic blood pressure in groups 1 and 2 was 134 mm Hg, in groups 3 and 4 – 129 mm Hg; diastolic blood pressure in groups 1 and 2 – 78.5 mm Hg, in groups 3 and 4 – 77.5 mm Hg.Conclusion. The maximum impact on adherence to AH treatment can be achieved with the introduction of a set of measures. However, the introduction of RBPM has a number of limitations associated with the additional economic burden and the lack of an approved methodology. However, the provision of treatment and prevention facilities with EMs does not require additional development of methodology and is significantly cheaper than the cost of modern blood pressure monitors.

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Is It Possible to Improve the Adherence to Treatment of Hypertension and Dyslipidemia in Patients Without Clinical Manifestations of Atherosclerosis?

Cited by 4 publications

References 5 publications

Adherence to antihypertensive medication in Russia: a scoping review of studies on levels, determinants and intervention strategies published between 2000 and 2017

Adherence to antihypertensive medication in Russia: a scoping review of studies on levels, determinants and intervention strategies published between 2000 and 2017

Adherence to Antihypertensive Therapy: A Systematic Review of Russian Prospective Studies from 2000 to 2019

The role of non-drug methods of increasing adherence to the treatment of patients with arterial hypertension in a polyclinic

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