Bloch Katia Vergetti, Melo André Nascimento de, Nogueira Armando R
Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
Cad Saude Publica. 2008 Dec;24(12):2979-84. doi: 10.1590/s0102-311x2008001200030.
This study estimated adherence to anti-hypertensive medication using three indirect methods and their combinations in a cohort of patients with resistant hypertension in Rio de Janeiro, Brazil, 2005. The methods used were: self-reported adherence; physicians' adherence evaluation; and the Morisky-Green test (MGT) translated into Portuguese. The predictive validation was performed comparing office blood pressure and ambulatory blood pressure monitoring, measured on two different occasions, from patients classified as adherent or not. The means were compared using non-parametric tests. Two hundred patients were interviewed. Mean age was 63 years (SD = 10.3), and 73.5% were female. Adherence prevalence was 51% using MGT, 52% according to the physician, and 80.5% according to the patient. Adherent patients showed a reduction in both office blood pressure and ambulatory blood pressure, while non-adherent patients did not. The use of more than one method to evaluate adherence showed that non-adherent individuals according to the three methods (11.9%) had the worst evolution in blood pressure levels. This finding suggests that resistant hypertension cannot be attributed exclusively to low adherence.
本研究于2005年在巴西里约热内卢的一组顽固性高血压患者中，使用三种间接方法及其组合来评估抗高血压药物的依从性。所使用的方法包括：自我报告的依从性；医生对依从性的评估；以及翻译成葡萄牙语的莫利斯基-格林测试（MGT）。通过比较在两个不同时间测量的诊室血压和动态血压监测结果，对分类为依从或不依从的患者进行预测性验证。使用非参数检验比较均值。共采访了200名患者。平均年龄为63岁（标准差 = 10.3），73.5%为女性。使用MGT得出的依从率为51%，医生评估的依从率为52%，患者自我报告的依从率为80.5%。依从的患者诊室血压和动态血压均有所下降，而非依从的患者则没有。使用多种方法评估依从性表明，根据三种方法均判定为不依从的个体（11.9%）血压水平的恶化情况最严重。这一发现表明，顽固性高血压不能仅仅归因于依从性低。
