Tilea Ioan, Petra Dorina, Voidazan Septimiu, Ardeleanu Elena, Varga Andreea
Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania.
Department M2-Functional and Complementary Sciences, Epidemiology Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania.
Patient Prefer Adherence. 2018 Apr 24;12:625-635. doi: 10.2147/PPA.S162965. eCollection 2018.
This study was performed to elucidate the level of adherence to antihypertensive treatment in adult subjects attending a family medicine clinic in a city in central Romania.
A cross-sectional, retrospective study was performed on a cohort of hypertensive adults. A total of 525 participants were selected from 1,714 adults attending a single urban family medicine practice. Assessment of adherence to therapy was performed by a chart review of prescription and clinical records over a 4-year study period.
The results showed that 69.8% of the patients had high adherence (>80% with therapy); 20.3% had medium adherence (20%-79%); and 9.9% had low adherence (<20%). A positive association was found ( = 0.01) between low adherence and male gender. A significant positive association ( = 0.02) was found between total cardiovascular risk and level of adherence. We found that 54.7% of the high adherence subjects had well-controlled blood pressure, and chronic kidney disease was associated with high adherence to therapy ( = 0.03). Antihypertensive regimens administered as fixed-dose combinations were positively associated with high adherence ( = 0.001). Subjects who had their antihypertensive regimen adjusted to a new drug class during the study period showed enhanced adherence compared to subjects treated with an unchanged regimen ( = 0.001).
This is the first published study assessing adherence to antihypertensive therapy in family medicine practice in Romania. It presented data derived from a primarily urban setting and targeted a geographical area where the prevalence of hypertension has increased continuously. Female gender, age, presence of cardiovascular risk factors, defined cardiovascular disease, chronic renal impairment, and good control of hypertension were positively associated with high adherence. The results provide insights to guide further strategies to improve adherence and indirect methods for blood pressure management strategies.
本研究旨在阐明罗马尼亚中部一个城市的一家家庭医学诊所中成年受试者对抗高血压治疗的依从性水平。
对一组高血压成年患者进行了一项横断面回顾性研究。从一家城市家庭医学诊所的1714名成年患者中总共选取了525名参与者。通过对4年研究期间的处方和临床记录进行图表审查来评估治疗依从性。
结果显示，69.8%的患者具有高依从性（治疗依从率>80%）；20.3%的患者具有中等依从性（20%-79%）；9.9%的患者具有低依从性（<20%）。发现低依从性与男性性别之间存在正相关（P = 0.01）。总心血管风险与依从性水平之间存在显著正相关（P = 0.02）。我们发现，54.7%的高依从性受试者血压得到良好控制，并且慢性肾脏病与高治疗依从性相关（P = 0.03）。以固定剂量组合给药的抗高血压方案与高依从性呈正相关（P = 0.001）。与接受不变治疗方案的受试者相比，在研究期间其抗高血压方案调整为新药物类别的受试者依从性有所提高（P = 0.001）。
这是罗马尼亚首次发表的评估家庭医学实践中抗高血压治疗依从性的研究。它呈现了主要来自城市环境的数据，并针对高血压患病率持续上升的地理区域。女性性别、年龄、心血管危险因素的存在、明确的心血管疾病、慢性肾功能损害以及高血压的良好控制与高依从性呈正相关。这些结果为指导进一步提高依从性的策略以及血压管理策略的间接方法提供了见解。
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