Blood Pressure Control in Patients with Ischemic Heart Disease in Comparison with Patients without Ischemic Heart Disease
The main condition for prevention of arterial hypertension (AH) complications, including in association with ischemic heart disease (IHD), is blood pressure (BP) reduction up to target level. IHD is considered as a factor that could influence antihypertensive treatment effectiveness. Until now, there is almost complete lack of definition and comparison of predictors for target BP achievement separately in populations of hypertensive patients with and without IHD. That’s why it was the objective of our study.
The study included 9821 patients (mean age 58.90 ± 0.24 years) with AH. All patients, depending on the signs of IHD, were divided into two groups: the first group — 4193 patients with IHD signs; the second group — 5628 patients with IHD signs. The diagnosis of IHD was made by exhibited attending physicians. 531 doctors in their sole discretion administered to patients with AH antihypertensive drugs in doses that they saw fit to prescribe. Monitoring the effectiveness of the treatment took place on visits — in total 4 visits for 3 months. During the visits, patients were underwent office BP measrument, electrocardiography, assessment of adherence to treatment using a standard questionnaire, evaluation of cardiovascular risk and a survey according to questionnaire developed by the authors on the study. Multifactorial regression analysis was used to identify independent predictors of lack of effectiveness of therapy.
It was found that the presence of IHD signs in patients with AH was associated with a greater incidence of complications (heart failure, kidney disease, stroke) and diabetes mellitus, risk factors (dyslipidemia, burdened history, older age, high BP), which required the appointment of more antihypertensive drugs. Patients without evidence of IHD often have bad habits, and additional physical activity, although it was in the vast majority of patients in this group, was not enough. Systolic (SBP) and diastolic (DBP) blood pressure in the second group was higher at the beginning of the study and at the end of the observation, despite the more intensive treatment (greater number of antihypertensive agents). Target BP (less than 140/90 mmHg) was achieved in 68.7 % of patients of the first group and only in 51.1 % of patients in the second group (P < 0.001). Groups of patients with and without IHD, among joint predictors of lack of effectiveness of therapy, have only a high level of SBP (> 160 mmHg) and DBP
(> 100 mmHg) at baseline: reliability increased by 3.83 and 2.81 and 3.92 and 2.5 times, respectively, for increased SBP and DBP in the first and second groups. In patients without IHD, probability of failure to reach target BP was also associated with increased body mass index (β = 1.033, P = 0.05) and a less frequent consumption of fresh fruits and vegetables (β = 12.8, P = 0.025). In the second group, the risk of ineffective treatment increased with the presence of concomitant heart failure (β = 1.73, P = 0.001) and decreased in the presence of essential, but not renoparenchymal AH (β = 0.76, P = 0.05). Higher cardiovascular risk in different ways was associated with the probability of lack of effectiveness of therapy: in the first group — increased (β = 1.46, P = 0.001) and in the second group, on the contrary, reduced (β = 0.52, P = 0.001). At baseline, only 28.3 % of the patients of the first group and 19.5 % of the second one (P < 0.001) had high adherence to treatment. High adherence to treatment at baseline contributed to a decrease in the probability of not achieving target BP by 36 % in the first group, whereas for patients with IHD it did not have an independent value. However, the high adherence at the end of the study in the second group was associated with a reduced risk of treatment failure by 46 %.
Thus, patients with AH with and without IHD had a different BP control and the various factors associated with achievement of its target level, allows to generate different management.
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