To evaluate the causes of low adherence to treatment in out-patients with newly diagnosed arterial hypertension without a history of cardiovascular events.
Material and methods
We studied medical records of 517 out-patients with newly diagnosed hypertension and conducted an anonymous survey of 651 primary care physicians.
Health care providers tended to recommend monotherapy as a first line treatment for arterial hypertension (49.6% according to the survey and 54.9% according to medical records). Free (22.1% and 21.9%, respectively) and fixed (24.3% and 23.3%) combinations of antihypertensive agents were used with the similar frequencies. Patients frequently did not follow the recommendations of physicians when free combinations were prescribed (43.2%). In medical records, references to the refusal of antihypertensive therapy were found in 14.3% of cases (complete in 8.1% and partial in 91.9%). The survey showed that the main reasons for low adherence to treatment were use of antihypertensive agents only in case of blood pressure increase (57.9%), forgetfulness of patients (44.2%), lack of complaints (42.2%), financial restrictions (27.3%). These findings were consistent with the results of medical records analysis. In cases of low adherence to treatment, 99.2% of physiciant do take certain actions, 87.4% provide additional information during face-to-face appointments, 51.0% hand out relevant educational data. However, according to the results of a retrospective analysis of medical records in case of partial or complete refusal of previously recommended antihypertensive, medical records with further recommendations aimed to increase adherence to treatment were found in only 43.2% of cases.
There is a need to develop a regulation for the management of outpatients with newly diagnosed arterial hypertension and low adherence to treatment, as well as monitoring tools to ensure the patients follow the guidelines.
Arterial hypertension, antihypertensive therapy, adherence to treatment