Reality of arterial hypertension treatment in Ukraine: the results of «СИСТЕМА 2» cohort study V.I. Tseluyko, on behalf of the group of researchers
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Abstract
The aim – to study the control of blood pressure in patients over 55 years of age suffering from arterial hypertension as part of primary care or family practice, the concordance of the treatment to the existing guidelines, and the effectiveness of therapy revision in view of the age-specific peculiarities of treatment.
Material and methods. 102 physicians from various regions of Ukraine took part in the «СИСТЕМА 2» study. It enrolled patients over 55 years of age who sought medical advice in out-patient clinics for arterial hypertension (a total of 2,040 patients).
Results. Among patients who took antihypertensive drugs (91.6 %), the mean SBP was 167 mm Hg, and achievement of the target level was observed only in 6.9 % of the cases. In the treatment of arterial hypertension in patients over 55 years of age, the age-specific peculiarities of development and treatment of arterial hypertension, presented in the guidelines, were not taken into account. RAAS blockers are commonly used in monotherapy and in combination therapy but not diuretics and/or calcium antagonists which are recommended. Therapy revision and prescription of the fixed combination of amlodipine and indapamide provides reduction of blood pressure and achievement of the target level in 67 % cases at 3 months. At the same time, there is a high compliance rate (96.6 % at 3 months).
Conclusions. Arterial hypertension control is extremely unsatisfactory in Ukraine. Mean office SBP in patients taking antihypertensive drugs is 167 mm Hg. Only 6.9 % of patients achieve goal SBP level. In treatment of patients aged 55 and up, age pecularities are not taken into account. The most widely used are RAAS inhibitors, instead of recommended diuretics and/or calcium channel blockers. Combination of amlodipine and indapamide provides achievement of goal SBP level after 3 months of treatment in 67 % of cases with high treatment compliance. Antihypertensive effect is more pronounced in patients with higher baseline BP, in patients switched from RAAS inhibitors, in co-administration with statins and in females. Antihypertensive effect is lower in smokers.
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