Wawruch Martin, Petrova Miriam, Celovska Denisa, Alfian Sofa D, Tesar Tomas, Murin Jan, Trnka Michal, Paduch Tomas, Aarnio Emma
Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
Front Pharmacol. 2024 Dec 18;15:1464689. doi: 10.3389/fphar.2024.1464689. eCollection 2024.
The benefit of secondary prevention in hypertensive patients with peripheral arterial disease (PAD) is based on continual simultaneous taking of statins, antiplatelet agents and antihypertensive agents, preferably angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). Our study was aimed at a) the analysis of the extent of non-persistence with multiple medication classes, and b) identifying factors associated with the likelihood of non-persistence.
In our cohort study, 3,401 hypertensive patients (1,853 females and 1,548 males) aged ≥65 years treated simultaneously with statins, antiplatelet agents and ACEIs/ARBs and in whom PAD was newly diagnosed during 2012 were analysed. A patient was classified as non-persistent when he/she was non-persistent with at least one of the three analysed medication classes. The most important characteristics associated with the probability of non-persistence were identified using the Cox regression.
At the end of the follow-up period (mean length 1.8 years), 1,869 (55.0%) patients (including 1,090 females and 779 males) were classified as non-persistent. In the whole study cohort, factors associated with non-persistence were female sex, atrial fibrillation, and being a new user of at least one of the analysed medication classes; in males, they were university education, atrial fibrillation, and epilepsy, and, in females, being a new user.
Identification of sex differences in factors associated with non-persistence makes it possible to determine the groups of patients in whom special attention should be paid to improving their persistence with a combination of medicines in order to ensure successful secondary prevention of PAD.
高血压合并外周动脉疾病（PAD）患者二级预防的益处基于持续同时服用他汀类药物、抗血小板药物和抗高血压药物，优选血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）。我们的研究旨在：a）分析多种药物类别治疗不依从的程度，以及b）确定与治疗不依从可能性相关的因素。
在我们的队列研究中，分析了2012年期间同时接受他汀类药物、抗血小板药物和ACEI/ARB治疗且新诊断为PAD的3401例年龄≥65岁的高血压患者（1853例女性和1548例男性）。当患者对三种分析的药物类别中至少一种治疗不依从时，该患者被分类为治疗不依从。使用Cox回归确定与治疗不依从可能性相关的最重要特征。
在随访期结束时（平均时长1.8年），1869例（55.0%）患者（包括1090例女性和779例男性）被分类为治疗不依从。在整个研究队列中，与治疗不依从相关的因素为女性、心房颤动以及是至少一种分析药物类别的新使用者；在男性中，这些因素为大学学历、心房颤动和癫痫，而在女性中则为新使用者。
识别与治疗不依从相关因素中的性别差异，有助于确定哪些患者群体应特别关注提高其联合用药的依从性，以确保成功进行PAD的二级预防。
