NON-ADHERENT BEHAVIOR IN PATIENTS WITH ANXIETY AND HYPERTENSION: FOCUS ON NON-PHARMACOLOGICAL TREATMENT AS A METHOD TO INCREASE COMPLIANCE

Aim. The analysis of non-adherent behavior factors, improvement of the management of patients with arterial hypertension (HT) and anxiety due to increase of compliance, by non-drug treatment in addition to antihypertensive drug therapy.

Material and methods. 209 patients with HT and anxiety were included into the study. Adherence to the drug therapy was assessed by Moriski Green's questionnaire. Anxiety disorders were diagnosed by the Hospital Anxiety and Depression Scale. Intensity of subjectively endured stress was estimated by the Visual Analogue Scale of stress at work and home, quality of life – by SF-36 questionnaire.

Results. 149 factors were studied and the factors influencing adherence to treatment were defined in this cohort of patients. On the basis of selected factors and results of binary logistical regression a forecasting technique for non-adherent behavior of patients with HT and anxiety was created. Changes in adherence to treatment after cycle of trainings atSchool ofHealth by the standard program (n=104) or after the same trainings with the special "Non-Drug Method of Influence" additionally (n=105) were assessed. Training of patients with HT and anxiety at School of Health with the use of "NonDrug Method of Influence" raised a level of adherence to drug antihypertensive therapy by 35.4Ѓ}3.3%, in comparison with initial data (χ.=8.96; р=0.049) with maintaining achieved results during 24 months of follow-up.

Conclusion. The basic advantage of "Non-Drug Method of Influence" is that exercises of a progressing muscular relaxation and operated mental visualization normalize blood pressure indices, raise adherence to drug antihypertensive treatment with maintaining achieved results during 24 months of follow-up.

1. Boytsov S.A. The structure of the factors of cardiovascular risk, and the quality of their prevention efforts in the primary care setting and Russia in European countries (according to the results of research EURIKA). Kardiovaskulyarnaya Terapiya i Profilaktika. 2012;11(1):11-6. (In Russ.) [Бойцов С.А. Структура факторов сердечно-сосудистого риска и качество мер их профилактики в первичном звене здравоохранения России и в Европейских странах (по результатам исследования EURIKA). Кардиоваскулярная Терапия и Профилактика. 2012;11(1):11-6].

2. Wadden T.A. Predicting treatment response to relaxation therapy for essential hypertension. J Nerv Ment Dis. 1983;171(11):683-9.

3. Medvedev V.E., Martynov S.E., Zverev K.V. et al. Psychosomatic diseases in cardiology (typology and clinical and dynamic characteristics). Psikhiatriya i Psikhofarmakoterapiya. 2012; 4: 34-41. (In Russ.) [Медведев В.Э., Мартынов С.Е., Зверев К.В. и др. Психосоматические заболевания в кардиологии (типология и клинико-динамические характеристики). Психиатрия и Психофармакотерапия. 2012;4:34-41].

4. Jones D.E., Carson K.A., Bleich S.N. et al. Patient trust in physicians and adoption of lifestyle behaviors to control high blood pressure. Patient Educ Couns. 2012;89(1):57-62.

5. Usenko A.G., Velichko N.P., Usenko G.A. et al. Characteristics of central nervous system activity in patients with complications of arterial hypertension and dependence on psychomotor status and treatment. Klin Med (Mosk). 2013;91(2):18-25. (In Russ) [Усенко А.Г., Величко Н.П., Усенко Г.А. и др. Показатели активности центральной нервной системы у больных артериальной гипертензией в зависимости от психосоматического статуса и лечения. Клиническая Медицина. 2013;91(2):18-25].

6. Garner J.B. Problems of nonadherence in cardiology and proposals to improve outcomes. Am J Cardiol. 2010;105(10):1495-501.

7. Coleman C.I., Limone B., Sobieraj D.M. et al. Dosing frequency and medication adherence in chronic disease. J Manag Care Pharm. 2012;18(7):527-39.

8. Natarajan N., Putnam W., Van Aarsen K. et al. Adherence to antihypertensive medications among family practice patients with diabetes mellitus and hypertension. Can Fam Physician. 2013;59(2):93-100.

9. Irvin M.R., Shimbo D., Mann D.M. et al. Prevalence and correlates of low medication adherence in apparent treatment-resistant hypertension. J Clin Hypertens (Greenwich). 2012; 14(10):694-700.

10. Jacob R.G., Shapiro A.P., O'Hara P. et al. Relaxation therapy for hypertension: setting-specific effects. Psychosom Med. 1992;54(1):87-101.

11. World Health Organization: Adherence to long-term therapies, evidence for aсtion. Available at: http://who/publications/2003/pdf/. Checked by December 11, 2012.

12. Chukaeva I.I., Orlova N.V., Kislyak O.A. et al. Health Schools for patients with cardiovascular diseases. Tutorial. Moscow: GOU VPO RSMU: 2011. (In Russ.) [Чукаева И.И., Орлова Н.В., Кисляк О.А. и др. Школы здоровья для больных сердечно-сосудистыми заболеваниями. Учебное пособие. Москва: ГОУ ВПО РГМУ: 2011].

13. Lloyd C.E. Screening for Depression and Other Psychological Problems in Diabetes (A Practical Guide). London: Springer-Verlig; 2013.