Factors Influencing the Blood Pressure Control in Patients with Renoparenchymal and Essential Hypertension

G.D. Radchenko, T.G. Slascheva, L.O. Mushtenko, Yu.M. Sirenko


The 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.


arterial hypertension; renal diseases; blood pressure control; factors-predictors of the lack of effectiveness of antihypertensive therapy


Настанова та клінічний протокол надання медичної допомоги «Артеріальна гіпертензія». Наказ МОЗ України № 384 від 24.05.2012. — К., 2012. — 107 с.

Сіренко Ю.М. Гіпертонічна хвороба та артеріальні гіпертензії. — К.: Здоров’я, 2009. — 240 с.

Сіренко Ю., Радченко Г., Марцовенко І. від імені учасників дослідження. Результати тримісячного спостереження за лікуванням пацієнтів з артеріальною гіпертензією лікарями загальної практики в Україні // Артеріальна гіпертензія. — 2009. — № 4. — С. 3-14.

2013 ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) // Journal of Hypertension. — 2013. — Vol. 31. — P. 1281-1357.

Akpaffiong M., Lawson M. Noncompliance to antihypertensive Drug therapy: a risk factor in Stroke-associated death in Minority populations // J. Hypertens. — 2004. — Vol. 17. — P. 68.

Azizi M., Menard J., Peyrard S. et al. Assessment of patient’s and physician’s compliance to an ACE inhibitor treatment based on urinary N-acetyl Ser-Asp-Lys-Pro determination in the noninsulin-dependent diabetes, hypertension, microalbuminuria, proteinuria, cardiovascular events, and ramipril (DIABHYCAR) study // Diabetes Care. — 2006. — Vol. 29. — P. 1331-1335.

Beddhu S., Wei G., Marcus R., Chonchol M., Greene T. Light-Intensity Physical Activities and Mortality in the United States General Population and CKD Subpopulation // Clin. J. Am. Soc. Nephrol. — 2015. — Vol. 10(7). — P. 1145-1153.

Buabeng K., Matowe L., Plange-Rhule J. Unaffordable drug prices: the major cause of non-compliance with hypertension medication in Ghana // J. Pharm. Pharm. Sci. — 2004. — Vol. 7. — P. 350-352.

Burnie M. Compliance in hypertension // EDTNA ERCA J. — 2005. — Vol. 31. — P. 152-155.

Colhoun H.M., Doug W., Poulter N.R. Blood pressure screening, management and control in England: results from the health survey for England // J. Hypertens. — 1998. — Vol. 16. — P. 747-752.

Contreras E., Guillen V., Martinez J.J. et al Analysis of studies published on hypertension treatment non-compliance in Spain between 1984 and 2005 // Aten. Primaria. — 2006. — Vol. 38. — 325-332.

Contreras E., von Wichmann M. de la Figuera, Ponsa L. еt al Compliance with hypertension therapy in Spain, according to the views of family doctors. Complex project // Intern. Emerg. Med. — 2006. — Vol. 1. — P. 204-208.

Fodor G., Kotrec M., Bacskai K. еt al. Is interview a reliable method to verify the compliance with antihypertensive therapy? An international central European study // J. Hypertens. — 2005. — Vol. 23. — P. 1261-1266.

Gascon J., Sanchez-Ortunob M., Llorc B. et al. for the Treatment Compliance in Hypertension Study Group. Why hypertensive patients do not comply with the treatment Results from a qualitative study // Family Practice. — 2004. — Vol. 21. — P. 125-130.

Gerbino P., Bramley T., Nightengale B. et al. Effect of medication compliance with antihypertensive therapy on blood pressure control // Am. J. Hypertens. — 2004. — Vol. 17. — P. 222A

Girerd X., Fourcade J., Brillet G. et al. The compliance evaluation test: a validated tool for detection of nonadherence among hypertensive treated patients // J. Hypertens. — 2001. — Vol. 19. — P. 74S.

Girerd X., Hanon O., Anagnostopoulos K. et al. Evaluation de l’observance du traitement antihypertenseur par un questionnaire: mise au point et utilization dans un service specialize // Presse Med. — 2001. — Vol. 30. — P. 1044-1048.

Lagi A., Rossi A., Passaleva M. et al. Compliance with therapy in hypertensive patients // Intern. Emerg. Med. — 2006. — Vol. 1. — P. 204-208

Mino-Leon D., Reyes-Morales H., Galvan-Plata M.E. et al. Drug treatment of hypertension: compliance and adverse reactions in a cohort of hypertensive patients in a primary care setting // Rev. Invest. Clin. — 2007. — Vol. 59. — P. 8-14.

Ostchega Y., Dillon C.F., Hughes J.P., Carroll M., Yoon S. Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults: data from the national health and nutrition examination survey 1988 to 2004 // J. Am. Geriatr. Soc. — 2007. — Vol. 55. — P. 1056-1065.

Peralta C.A., Hicks L.S., Chertow G.M. еt al. Control of hypertension in adults with chronic kidney disease in the Uni­ted States // Hypertension. — 2005. — Vol. 45. — P. 1119-1124.

Plantinga L., Miller E., Stevens L. et al. Blood Pressure Control Among Persons Without and With Chronic Kidney Disease: US Trends and Risk Factors 1999–2006 // Hypertension. — 2009. — Vol. 54. — P. 47-56

Rao M.V., Qiu Y., Wang C., Bakris G. Hypertension and CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES), 1999–2004 // Am. J. Kidney Dis. — 2008. — Vol. 51. — P. 30-37.

Rizzo J., Simons W. Variations in compliance among hypertensive patients by drug class: implications for health care costs // Clin. Ther. — 1997. — Vol. 19. — P. 1446-1457

Sarafidis P.A., Li S., Chen S.C. et al. Hypertension awareness, treatment, and control in chronic kidney disease // Am. J. Med. — 2008. — Vol. 121. — P. 332-340.

DOI: https://doi.org/10.22141/2224-1485.5.49.2016.83862


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