RESISTANT HYPERTENSION: THE AWARENESS OF DOCTORS AND THE EFFECTIVENESS OF THE COMBINATION THERAPY
https://doi.org/10.20996/1819-6446-2016-12-2-176-179
Abstract
Aim. To study the doctor awareness of the criteria of resistant hypertension (RHT) and to evaluate the features of the combination therapy of RTH patients in outpatient clinics. Material and methods. An analysis of medical records of patients with hypertension (n=1000) in 5 outpatient clinics in Moscow was made. A group of patients (n=126) with difficult to control hypertension 2-3 degrees, that internists considered as RTH, was specified. A survey of internists (n=78) of these outpatient clinics was also performed using a special questionnaire, which included questions on diagnosis and management of patients with RTH.
Results. 47% of doctors were not able to give a clear RTH definition. About 75% of internists prefer to increase the drug doses consistently in spite of its low initial efficacy. 20% of physicians used triple combination in the initial treatment of RHT. More than 40% of patients received not enough effective drug combinations.
Conclusion. Doctor awareness of RHT diagnostic criteria and management remained insufficient. RHT treatment is carried out with the use of not enough effective antihypertensive combinations and with low doses of drugs.
About the Authors
R. R. Kushkhova
Russian Medical Academy of Postgraduate Education, Moscow
Russian Federation
Russian Federation
A. G. Avtandilov
Russian Medical Academy of Postgraduate Education, Moscow
Russian Federation
Russian Federation
A. A. Pukhaeva
Russian Medical Academy of Postgraduate Education, Moscow
Russian Federation
Russian Federation
References
1. Shalnova SA, Balanova YuA, Konstantinov VV, et al Arterial hypertension: prevalence, awareness, antihypertensive drugs and the effectiveness of treatment among the Russian population. Rossiyskiy Kardiologicheskiy Zhurnal 2006; 4: 45-50. In Russian (Шальнова С. А., Баланова Ю. А., Константинов В. В. и др. Артериальная гипертензия: распространенность, осведомленность, прием антигипертензивных препаратов и эффективность лечения среди населения Российской Федерации. Российский Кардиологический Журнал 2006; (4): 45-50).
2. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 2008; 51:1403-19.
3. 2013 ESH/ESC Guidelines for management of arterial hypertension J Hypertens 2013; 31: 1281-357.
4. Daugherty SL, Powers JD, Magid DJ, et al. Incidence and Prognosis of Resistant Hypertension in Hypertensive Patients. Circulation 2012;125:1635-42.
5. Sarafidis P. A. Epidemiology of resistant hypertension. J Clin Hypertens (Greenwich) 2011;13: 523-8.
6. Kaplan N. M. Resistant hypertension. J Hypertens 2005; 23:1441-4.
7. Emelyanov IV, Protasov KV, Konradi AO. The ratio of practitioners to achieve target blood pressure levels and following the recommendations for the treatment of hypertension. The problem of medical inertia. Arterial'naya Gipertenziya 2012; 18 (3): 191-8. In Russian (Емельянов И.В., Протасов К. В., Конради А.О. Отношение практических врачей к достижению целевого уровня артериального давления и следованию рекомендациям по лечению артериальной гипертензии. Проблема врачебной инертности. Артериальная Гипертензия 2012;18(3):191-8).
8. Phillips LS, Branch WT, Cook CB, et al. Clinical inertia. Ann Intern Med 2001; 135:825-34.
9. O’Connor PJ, Sperl-Hillen JM, Johnson PE, et al. Clinical inertia and outpatient medical errors. Advances in Patient Safety 2005;2:293-308.
10. Egan BM, Basile JN. Controlling blood pressure in 50% of all hypertensive patients: an achievable goal in the Healthy People 2010 Report? J Investig Med 2003;51: 373-85.
11. Garg J., Elliot W.J., Folker A. et al. RUSH University Hypertension Service. Resistant hypertension revisited: a comparison of two university-based cohorts. Am J Hypertens 2005; 18:619-26.
12. Kobalava ZD, Kotovskaya JV, Starostina EG, et al. The problem of interaction between doctor and patient, and control of arterial hypertension in Russia. The main results of the scientific-practical program ARGUS-2. Krdiologiia 2007; 47 (3): 38-47. In Russian (Кобалава Ж.Д., Котовская Ю.В., Старостина Е.Г. с соавт. Проблема взаимодействия врача и пациента и контроль артериальной гипертонии в России. Основные результаты научно-практической программы АРГУС-2. Кардиология 2007;47(3):38-47).
13. Ramsey L.E., Silas J.E., Freestone S. Diuretic treatment of resistant hypertension. Br Med J 1980; 281: 1101-3.
14. Chapman N, Dobson J, Wilson S, et al. Anglo-Scandinavian Cardiac Outcomes Trial Investigators. Effect of spironolactone on blood pressure in subjects with resistant hypertension. Hypertension 2007; 49: 839-45.
15. Vaclavik J, Sedlak R, Plachy M, et. al. Addition of spironolactone in patients with resistant arterial hypertension (ASPIRANT). Hypertension 2011; 57: 1069-75.
Review
For citations:
Kushkhova R.R., Avtandilov A.G., Pukhaeva A.A. RESISTANT HYPERTENSION: THE AWARENESS OF DOCTORS AND THE EFFECTIVENESS OF THE COMBINATION THERAPY. Rational Pharmacotherapy in Cardiology. 2016;12(2):176-179. (In Russ.) https://doi.org/10.20996/1819-6446-2016-12-2-176-179
Views:
857
Email this article 