Hamrahian Seyed Mehrdad, Maarouf Omar H, Fülöp Tibor
Department of Medicine - Nephrology, Thomas Jefferson University, Philadelphia, PA, USA.
Department of Medicine - Nephrology, Medical University of South Carolina, Charleston, SC, USA.
Patient Prefer Adherence. 2022 Oct 7;16:2749-2757. doi: 10.2147/PPA.S368784. eCollection 2022.
Hypertension is a global public health problem, and its prevalence is increasing worldwide. Impacting all human societies and socioeconomic strata, it remains the major modifiable risk factor for global burden of cardiovascular disease all-cause mortality and the leading cause of loss of disability-adjusted life years. Despite increased awareness, the rate of blood pressure control remains unsatisfactory, particularly in low- to middle-income countries. Apparent treatment-resistant hypertension is associated with worse adverse health outcomes. It includes both true resistant and pseudo-resistant hypertension, which requires out-of-office blood pressure monitoring to exclude white-coat effect and confirmation of adherence to the agreed recommended antihypertensive therapy. The depth of medication non-adherence remains poorly recognized among medical practitioners, thus presenting an underestimated modifiable risk factor. Medication non-adherence is a complex and multidimensional variable with three quantifiable phases: initiation, implementation, and discontinuation, collectively called persistence. Non-adherence can be both intentional and non-intentional and usually involves several interconnected factors. Persistence declines over time in the treatment of chronic diseases like hypertension. The risk is higher in patients with new diagnosis, poor insurance status, polypharmacy, and multiple comorbidities, particularly psychiatric disorders. The World Health Organization divides the contributing factors impacting adherence into five categories. Screening and detection for medication non-adherence are challenging due to its dynamic nature and potential white-coat effect. Easy-to-conduct screening methods have low reliability and validity, whereas more reliable and valid methods are costly and difficult to perform. Medication non-adherence is associated with poor clinical outcome and potential negative impact on health-care costs. Evaluation of adherence should become an integral part of assessment of patients treated for hypertension. Medication adherence can significantly improve with a patient-centered approach, non-judgmental communication skills, and collaborative multidisciplinary management, including engagement of the patients in their care by self-blood pressure monitoring.
高血压是一个全球性的公共卫生问题，其患病率在全球范围内呈上升趋势。它影响着所有人类社会和社会经济阶层，仍然是全球心血管疾病负担、全因死亡率的主要可改变风险因素，也是导致伤残调整生命年损失的主要原因。尽管人们的认识有所提高，但血压控制率仍然不尽人意，尤其是在低收入和中等收入国家。明显的难治性高血压与更差的不良健康结局相关。它包括真正的难治性高血压和假性难治性高血压，这需要进行诊室外血压监测以排除白大衣效应，并确认是否坚持商定的推荐抗高血压治疗。医生对药物治疗不依从的严重程度认识不足，因此这是一个被低估的可改变风险因素。药物治疗不依从是一个复杂的多维度变量，有三个可量化阶段：起始、实施和停药，统称为持续性。不依从可以是有意的，也可以是无意的，通常涉及几个相互关联的因素。在高血压等慢性病的治疗中，持续性会随着时间的推移而下降。新诊断患者、保险状况不佳、联合用药和多种合并症患者，尤其是患有精神疾病的患者，风险更高。世界卫生组织将影响依从性的促成因素分为五类。由于药物治疗不依从的动态性质和潜在的白大衣效应，对其进行筛查和检测具有挑战性。易于实施的筛查方法可靠性和有效性较低，而更可靠和有效的方法成本高昂且难以实施。药物治疗不依从与不良临床结局以及对医疗成本的潜在负面影响相关。对依从性的评估应成为高血压治疗患者评估的一个组成部分。采用以患者为中心的方法、非评判性沟通技巧和协作性多学科管理，包括让患者通过自我血压监测参与自身护理，可以显著提高药物依从性。
