Прямые методы оценки приверженности к антигипертензивной терапии: контролируемый прием препаратов и терапевтический лекарственный мониторинг

Низкая приверженность к терапии – одна из основных причин псевдорезистентной артериальной гипертензии (АГ), сопряжена с повышением риска сердечно-сосудистых осложнений и увеличением прямых и непрямых медицинских затрат. Оценка приверженности является важным элементом в ведении пациентов с неконтролируемой АГ, особенно при подозрении на устойчивость к терапии. «Золотого стандарта» оценки приверженности к терапии нет и поэтому, кроме непрямых методов, хотя и простых, но довольно ненадежных, в последнее время все чаще используются прямые способы — контроль приема препаратов в присутствии медперсонала, которые проводятся на фоне повторного мониторирования артериального давления при помощи портативных устройств или повторных его измерений специалистом, а также терапевтический мониторинг лекарственных препаратов или метаболитов в биологических жидкостях с использованием ультра-высокоэффективной жидкостной хроматографии с тандемной масс-спектрометрией. В данном описательном обзоре представлены ключевые результаты исследований по применению этих методов, рассмотрены их ограничения и преимущества, а также даны практические рекомендации по внедрению этих подходов в повседневную клиническую практику. Симультанное и как можно более раннее их применение позволяет исключить в ряде случаев необходимость в дополнительных сложных и затратных лечебно-диагностических процедурах, а также более точно и надежно выделить группу пациентов с истинно резистентной АГ — когорту, которая представляет наибольший научно-практический интерес. Использование рассмотренных подходов повышает клинико-экономическую эффективность лечения, помогает выявить парамедицинские проблемы и укрепляет взаимодействие между врачом и пациентом.

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