Factors Influencing the Blood Pressure Control in Patients with Renoparenchymal and Essential Hypertension
Keywords:arterial hypertension, renal diseases, blood pressure control, factors-predictors of the lack of effectiveness of antihypertensive therapy
AbstractThe aim of our study was to compare blood pressure (BP) control in wide Ukrainian population of patients with essential and renoparenchymal arterial hypertension (AH) and to evaluate the factors associated with failure to achieve BP control during 3-month antihypertensive therapy, separately in each group. The analysis included data of 9259 patients. All patients depending on the cause of AH were divided in two groups. The first group consisted of 2197 (23.7 %) individuals with renoparenchymal AH; the second one — of 7062 (76.3 %) patients with essential AH. 531 physicians on their discretion prescribed antihypertensive drugs in the doses they considered necessary. Monitoring the effectiveness of treatment was performed during 4 visits within 3 months. Patients during visits were measured office BP, underwent electrocardiography, evaluation of the compliance using standard questionnaire, assessment of cardiovascular risk and survey according to the questionnaire developed by the authors of the study. Multiple regression analysis was used to identify independent predictors of the lack of treatment efficacy. It was found that renoparenchymal AH compared with essential AH was associated with a greater incidence of complications (heart failure, stroke), concomitant conditions (coronary heart disease, diabetes mellitus), risk factors (dyslipidemia, age, obesity, family history, high systolic BP), and these patients had more lesions of target organs (left ventricular hypertrophy, renal dysfunction). Target BP (< 140/90 mmHg) was achieved in 53.9 % of patients in the first group and in 60.7 % (P < 0.001) patients in the second group. Compared to the second group, the average number of drugs received by the patients with renoparenchymal AH and the frequency of the use of combination therapy were significantly higher — 2.20 ± 0.02 vs 2.04 ± 0.01 (P < 0.001) and 64 vs 57.1 % (P < 0.001), respectively. In both groups at baseline only a small number of patients had high adherence — 20.1 and 23.5 %, respectively, in the first and second groups (P < 0.001). Improving adherence of patients to the treatment was observed in both groups: the proportion of patients with low adherence significantly reduced and the proportion with high and moderate — increased. But at the end of the study, more patients with renoparenchymal AH than those with essential AH were characterized as patients with low adherence. In both groups, poor control of BP was associated with the initial level of systolic and diastolic blood pressure. Higher adherence to the treatment at the end of the study (not at baseline) and the use of fresh vegetables and fruits reduced the likelihood of poor control of BP in both groups as well. In people with renoparenchymal AH, older age and greater number of drugs were associated with failure to achieve target BP, while additional physical activity, on the contrary, increased the chances of successful treatment. The presence of heart failure and myocardial infarction in the past medical history increased the probability of failure to achieve target BP only in patients of the second group. Higher education and work status reduced the likelihood of failure to achieve target BP only in patients with essential AH. Therefore, patients with renoparenchymal AH were more severe patients with AH, and they need more attention and more aggressive management and correction of other risk factors, not just BP. Identified common and different factors associated with the lack of target BP achievement should be considered for more effective management of patients with AH of different etiologies.
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