Factors associated with patient’s compliance to antihypertensive treatment
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Abstract
The aim – to evaluate factors related to the compliance and its changes during antihypertensive treatment.
Material and methods. We included 10 158 hypertensive patients, treated by 531 general practice physicians. Physicians administered antihypertensive therapy based on domestic generic drugs (bisoprolol, enalapril, fixed combination enalapril and hydrochlorthiazide, amlodipine) during 3 months. Every patient had four visits to the physician’s office with evaluation of the office blood pressure and heart rate, ECG patterns, compliance (by questionnaire).
Results. It was shown that 43.2 % hypertensive patients had low (< 50 % taking prescribed drugs) compliance baseline. Factors associated with poor compliance were older age, presence of coronary heart disease, myocardial infarction, stroke or heart failure, lifestyle (higher body mass index, smoking, alcohol abuse, low physical activity, low consumption of fresh fruits and vegetables, high salt consumption), low education and absence of work (or being retired). The level of blood pressure was higher in patients with baseline low compliance at all 4 visits. The target blood pressure was not achieved in 33.5 % patients with high compliance, in 39,9 % with baseline moderate compliance (P<0.001 vs high) and in 47.6 % (P<0.001 vs high and 0.005 with moderate) with low baseline compliance. In 61.7 % patients we noted improving of the compliance. Independent factors associated with final visit compliance were age (β=–0.024, Р=0.018), baseline compliance (β=0.61, P<0.001), level of systolic (β=–0.05, P<0.001) and diastolic (β=–0.04, P<0.001) blood pressure at the end of the study, presence of adverse reactions (β=–0.04, P<0,001), alcohol abuse (β=–0.03, P=0.004), physical activity (β=0.034, P=0.002), consumption of fresh vegetables and fruits (β=0.026, P=0.02).
Conclusion. Administration of fixed combination of enalapril and hydrochlorthiazide and higher doses of bisoprolol and amlodipine, as well as printed recommendations for lifestyle modification were related to better compliance at the end of the study.
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