Antihypertensive therapy in the outpatient practice of the family physician and cardiologist: focus on adherence to combination therapy — results of the ATMOSPHERA study
Keywords:antihypertensive therapy, fixed-dose combinations, target blood pressure
Background. Recently, the demand for antihypertensive combinations during the outpatient phase has increased in Ukraine, but the data on the frequency of use of fixed-dose combinations have not been previously provided. The purpose of the study was to evaluate the actual practice of using fixed-dose combinations at the outpatient stage of medical care in Ukraine and to compare the effectiveness of olmesartan-based combinations with routine use of other antihypertensive drugs, including other fixed-dose combinations. With the support of Zentiva Ukraine, ATMOSPHERA study (Antihypertensive therapy in the outpatient practice of the family physician and cardiologist: focus on adherence to combination therapy) was carried out. Materials and methods. It was an open-label prospective population phase IV study. Recruitment of patients was conducted from September 2020 to September 2021. The study data were analyzed from June to November 2021. Methods: collection of complaints and anamnesis, physical examination, evaluation of the data of instrumental and laboratory studies in terms of matching the criteria for inclusion/non-inclusion in the study, assessment of adherence to therapy using the Morisky-Green questionnaire. Treatment: the doctor’s choice of antihypertensive therapy at his own discretion, including the choice of any of the new combinations — Sevikar, Olmetec Plus or Sevikar HCT. Results. A total of 1,405 patients were included in the study, but only 915 individuals completed full treatment and attended all scheduled appointments. People included in the study were mostly middle-aged, among them there were slightly more men, only 8 % of patients were treatment-naїve in terms of antihypertensive therapy, the average blood pressure was approximately 160/93 mmHg. More than 60 % of enrolled patients indicated that they took single-pill fixed-dose combinations, but adherence to treatment was low according to the questionnaire. Among olmesartan combinations, Olmetec Plus and Sevikar HCT were used most frequently — 35 and 26 %, respectively. The degree of blood pressure reduction was greater in both groups of therapy with olmesartan-based combinations. Importantly, when using triple combination of olmesartan, amlodipine, and hydrochlorothiazide, the reduction in blood pressure was significantly greater than in the group of treatment with other antihypertensive agents. Moreover, even in the group of combination dual olmesartan therapy, the reduction in blood pressure was also greater. This suggests that olmesartan-based combinations have potent antihypertensive effects, even compared to other drugs and combinations. In addition, it was found that at the time of enrollment, almost 56.7 % of patients had missed antihypertensive therapy, compared to only 9 % at the end of the study. Conclusions. In the structure of prescriptions of antihypertensive therapy at the outpatient stage, combinations of angiotension-converting enzyme inhibitors with diuretics prevail, while calcium channel blockers were prescribed less frequently. The use of fixed-dose combinations significantly improved patient adherence. Single-pill fixed-dose combination therapy based on olmesartan — Olmetec Plus, Sevikar and Sevikar HCT — showed a strong antihypertensive effect, and the proportion of patients who achieved effective blood pressure control in this group was the largest. Olmesartan-based fixed-dose combinations provide better blood pressure control than treatment with other drugs, ensuring the achievement of target blood pressure in 83.5 % of cases.
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