{"title":"心肌梗死后长期高血压患者的治疗依从性及影响治疗质量的因素","authors":"A. Yagensky, M. Pavelko","doi":"10.25040/lkv2022.01-02.028","DOIUrl":null,"url":null,"abstract":"Introduction. Adherence to the treatment of arterial hypertension (AH) after myocardial infarction (MI) remains an understudied problem in world cardiology. The aim of the study. Assess adherence to treatment and the factors that affect it in patients with AH in the remote period after MI. Materials and methods. The study included 265 patients after MI (68.2 % of men, mean age 65.4 ± 9.5 years). The mean time from MI to inclusion in the study was 2.3 ± 1.9 years. Assessment of the quality of secondary prevention was performed by analyzing the results of the questionnaire, measuring of anthropometric parameters, blood pressure (BP) and heart rate (HR), as well as determining lipid metabolism, creatinine and venous blood glucose. Results. The frequency of detection of AH in the long period after MI is 69.1 %, regardless of gender, time of MI and its variant and increases in proportion to age. Only in 26.3 % of patients with hypertension in the remote period after MI BP was within the target values. Factors associated with achieving the target values of BP were age up to 60 years (OR – 1.35; p is equal to 0.02), a visit to the doctor during the last 6 months (OR – 1.82; p is equal to 0.002), regular independent blood pressure measurement (OR – 1.63; p is equal to 0.01). 13.3 % of patients with AH after MI did not take antihypertensive drugs, the remaining 60.4 % of patients with AH were treated but did not reach the target BP. Among patients with AH after MI who did not take antihypertensive drugs, patients older than 60 years prevailed (83.3 % vs. 63.2 % of treated patients, p = 0.05). In addition, much less often these patients were under the supervision of a doctor – 47.4 % vs. 82.8 % (p is equal to 0.0005), including a cardiologist (40.9 % vs. 75.0 %, p is equal to 0.001), less visited a doctor for a year, had lower BP, and had poorer knowledge of post-MI treatment. In addition, none of them use statins. Patients with AH who received treatment but did not reach the target BP values received the same amount of antihypertensive drugs as patients with controlled AH – an average of 2.1 ± 1.0 and 2.1 ± 0.9 drugs, respectively. At the same time, 29.3 % of patients in the group of ineffectively treated AH received monotherapy. No differences were found between age, sex, basic clinical and social parameters, financial status, health knowledge, self-measurement of blood pressure, or frequency of physician visits. Conclusions. To achieve the target BP levels in patients with AH after MI, it is necessary to: introduce regular measurement of home BP in all patients; use combination antihypertensive therapy, including, if necessary, with the use of three or more drugs; regularly monitor adherence to treatment, use of antiplatelet, antihypertensive drugs and statins. Patients with difficult-to-control AH should consult a cardiologist at least every 6 months.","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"1 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Adherence to Treatment and Factors Influencing the Quality of Treatment of Hypertension in Patients in the Long Term After Myocardial Infarction\",\"authors\":\"A. Yagensky, M. Pavelko\",\"doi\":\"10.25040/lkv2022.01-02.028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction. Adherence to the treatment of arterial hypertension (AH) after myocardial infarction (MI) remains an understudied problem in world cardiology. The aim of the study. Assess adherence to treatment and the factors that affect it in patients with AH in the remote period after MI. Materials and methods. The study included 265 patients after MI (68.2 % of men, mean age 65.4 ± 9.5 years). The mean time from MI to inclusion in the study was 2.3 ± 1.9 years. Assessment of the quality of secondary prevention was performed by analyzing the results of the questionnaire, measuring of anthropometric parameters, blood pressure (BP) and heart rate (HR), as well as determining lipid metabolism, creatinine and venous blood glucose. Results. The frequency of detection of AH in the long period after MI is 69.1 %, regardless of gender, time of MI and its variant and increases in proportion to age. Only in 26.3 % of patients with hypertension in the remote period after MI BP was within the target values. Factors associated with achieving the target values of BP were age up to 60 years (OR – 1.35; p is equal to 0.02), a visit to the doctor during the last 6 months (OR – 1.82; p is equal to 0.002), regular independent blood pressure measurement (OR – 1.63; p is equal to 0.01). 13.3 % of patients with AH after MI did not take antihypertensive drugs, the remaining 60.4 % of patients with AH were treated but did not reach the target BP. Among patients with AH after MI who did not take antihypertensive drugs, patients older than 60 years prevailed (83.3 % vs. 63.2 % of treated patients, p = 0.05). In addition, much less often these patients were under the supervision of a doctor – 47.4 % vs. 82.8 % (p is equal to 0.0005), including a cardiologist (40.9 % vs. 75.0 %, p is equal to 0.001), less visited a doctor for a year, had lower BP, and had poorer knowledge of post-MI treatment. In addition, none of them use statins. Patients with AH who received treatment but did not reach the target BP values received the same amount of antihypertensive drugs as patients with controlled AH – an average of 2.1 ± 1.0 and 2.1 ± 0.9 drugs, respectively. At the same time, 29.3 % of patients in the group of ineffectively treated AH received monotherapy. No differences were found between age, sex, basic clinical and social parameters, financial status, health knowledge, self-measurement of blood pressure, or frequency of physician visits. Conclusions. To achieve the target BP levels in patients with AH after MI, it is necessary to: introduce regular measurement of home BP in all patients; use combination antihypertensive therapy, including, if necessary, with the use of three or more drugs; regularly monitor adherence to treatment, use of antiplatelet, antihypertensive drugs and statins. Patients with difficult-to-control AH should consult a cardiologist at least every 6 months.\",\"PeriodicalId\":279640,\"journal\":{\"name\":\"Lviv clinical bulletin\",\"volume\":\"1 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-06-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lviv clinical bulletin\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.25040/lkv2022.01-02.028\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lviv clinical bulletin","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.25040/lkv2022.01-02.028","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
介绍。心肌梗死(MI)后动脉高血压(AH)的治疗依从性仍然是世界心脏病学研究不足的问题。研究的目的。评估心肌梗死后远期AH患者的治疗依从性及影响治疗依从性的因素。材料和方法。研究纳入了265例心肌梗死患者(68.2%为男性,平均年龄65.4±9.5岁)。从心肌梗死到纳入研究的平均时间为2.3±1.9年。通过分析调查问卷结果,测量人体测量参数、血压(BP)、心率(HR),测定脂质代谢、肌酐、静脉血血糖,评价二级预防的质量。结果。心肌梗死后长时间内AH的检出率为69.1%,与性别、心肌梗死时间及其变异无关,且随年龄的增长呈比例增加。只有26.3%的高血压患者在心肌梗死后的远期血压在目标值内。与达到血压目标值相关的因素有:60岁以下(OR - 1.35;p = 0.02),在过去6个月内看过一次医生(OR - 1.82;p = 0.002),定期独立血压测量(OR - 1.63;P = 0.01)。13.3%的心肌梗死后AH患者未服用降压药物,其余60.4%的AH患者虽接受治疗但未达到目标血压。在心肌梗死后并发AH且未服用降压药物的患者中,年龄大于60岁的患者占多数(83.3% vs 63.2%, p = 0.05)。此外,这些患者很少接受医生的监督(47.4% vs. 82.8% (p = 0.0005),包括心脏病专家(40.9% vs. 75.0%, p = 0.001),一年之内看医生的次数较少,血压较低,对心肌梗死后治疗的了解较差。此外,他们都不使用他汀类药物。接受治疗但未达到目标值的AH患者与控制AH患者服用的降压药量相同,平均分别为2.1±1.0和2.1±0.9。同时,治疗无效的AH组中有29.3%的患者接受了单药治疗。年龄、性别、基本临床和社会参数、经济状况、健康知识、自我测量血压或就诊频率之间没有差异。结论。为了使心肌梗死后AH患者的血压达到目标水平,有必要:在所有患者中引入定期的家庭血压测量;使用联合降压治疗,包括必要时使用三种或三种以上药物;定期监测治疗依从性,使用抗血小板,抗高血压药物和他汀类药物。难以控制的AH患者应至少每6个月咨询一次心脏病专家。
Adherence to Treatment and Factors Influencing the Quality of Treatment of Hypertension in Patients in the Long Term After Myocardial Infarction
Introduction. Adherence to the treatment of arterial hypertension (AH) after myocardial infarction (MI) remains an understudied problem in world cardiology. The aim of the study. Assess adherence to treatment and the factors that affect it in patients with AH in the remote period after MI. Materials and methods. The study included 265 patients after MI (68.2 % of men, mean age 65.4 ± 9.5 years). The mean time from MI to inclusion in the study was 2.3 ± 1.9 years. Assessment of the quality of secondary prevention was performed by analyzing the results of the questionnaire, measuring of anthropometric parameters, blood pressure (BP) and heart rate (HR), as well as determining lipid metabolism, creatinine and venous blood glucose. Results. The frequency of detection of AH in the long period after MI is 69.1 %, regardless of gender, time of MI and its variant and increases in proportion to age. Only in 26.3 % of patients with hypertension in the remote period after MI BP was within the target values. Factors associated with achieving the target values of BP were age up to 60 years (OR – 1.35; p is equal to 0.02), a visit to the doctor during the last 6 months (OR – 1.82; p is equal to 0.002), regular independent blood pressure measurement (OR – 1.63; p is equal to 0.01). 13.3 % of patients with AH after MI did not take antihypertensive drugs, the remaining 60.4 % of patients with AH were treated but did not reach the target BP. Among patients with AH after MI who did not take antihypertensive drugs, patients older than 60 years prevailed (83.3 % vs. 63.2 % of treated patients, p = 0.05). In addition, much less often these patients were under the supervision of a doctor – 47.4 % vs. 82.8 % (p is equal to 0.0005), including a cardiologist (40.9 % vs. 75.0 %, p is equal to 0.001), less visited a doctor for a year, had lower BP, and had poorer knowledge of post-MI treatment. In addition, none of them use statins. Patients with AH who received treatment but did not reach the target BP values received the same amount of antihypertensive drugs as patients with controlled AH – an average of 2.1 ± 1.0 and 2.1 ± 0.9 drugs, respectively. At the same time, 29.3 % of patients in the group of ineffectively treated AH received monotherapy. No differences were found between age, sex, basic clinical and social parameters, financial status, health knowledge, self-measurement of blood pressure, or frequency of physician visits. Conclusions. To achieve the target BP levels in patients with AH after MI, it is necessary to: introduce regular measurement of home BP in all patients; use combination antihypertensive therapy, including, if necessary, with the use of three or more drugs; regularly monitor adherence to treatment, use of antiplatelet, antihypertensive drugs and statins. Patients with difficult-to-control AH should consult a cardiologist at least every 6 months.