arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2022-28-6-109-118arthyper-2285Research ArticleОРИГИНАЛЬНАЯ СТАТЬЯORIGINAL ARTICLEОценка приверженности к терапии у коморбидных больныхAssessment of adherence to therapy in comorbid patientshttps://orcid.org/0000-0002-1250-8798ХидироваЛ. Д.KhidirovaL. D.

Хидирова Людмила Даудовна — д–р мед. наук, профессор кафедры фармакологии, клинической фармакологии и доказательной медицины 

Lyudmila D. Khidirova, MD, PhD, DSc, Professor, Department of Pharmacology, Clinical Pharmacology and Evidence-Based Medicine

h_ludmila73@mail.ruhttps://orcid.org/0000-0003-4735-5178ЯхонтовД. А.YakhontovD. A.

Яхонтов Давыд Александрович — д–р мед. наук, профессор кафедры фармакологии, клинической фармакологии и доказательной медицины 

Davyd A. Yakhontov, MD, PhD, DSc, Professor, Department of Pharmacology, Clinical Pharmacology and Evidence-Based Medicine

p_yakhont@mail.ruhttps://orcid.org/0000-0002-1093-8938МадоновП. Г.MadonovP. G.

Мадонов Павел Геннадьевич — д–р мед. наук, профессор, зав. кафедрой  фармакологии, клинической фармакологии и доказательной медицины 

Pavel G. Madonov, MD, PhD, DSc, Professor, Department of Pharmacology, Clinical Pharmacology and Evidence-Based Medicine

madonov@scpb.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Новосибирский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияNovosibirsk State Medical UniversityRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Новосибирский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииRussian FederationNovosibirsk State Medical UniversityRussian Federation202327012023291109118Copyright © Хидирова Л.Д., Яхонтов Д.А., Мадонов П.Г., 20232023Хидирова Л.Д., Яхонтов Д.А., Мадонов П.Г.Khidirova L.D., Yakhontov D.A., Madonov P.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/2285

Цель исследования — оценить приверженность терапии у пациентов с артериальной гипертензией (АГ) и фибрилляцией предсердий (ФП) в сочетании с экстракардиальной коморбидной патологией. Материалы и методы. В обсервационном когортном исследовании наблюдалось 884 пациента 45–65 лет с ФП (пароксизмальная и персистирующая форма) и АГ, в сочетании с экстракардиальными коморбидными заболеваниями: сахарный диабет (СД), n = 123; абдоминальное ожирение (АО), n = 171; хроническая обструктивная болезнь легких (ХОБЛ), n = 137, гипотиреоз, n = 156; тиреотоксикоз, n =112. Группу сравнения составили 185 пациентов с ФП и АГ, без сопутствующей экстракардиальной патологии. В работе оценивались клинические, антропометрические показатели, тест для оценки приверженности Мориски–Грина. Все статистические расчеты проводили в программе Rstudio. Результаты. Среди больных с ФП и АГ было выявлено 66 % с сопутствующей экстракардиальной коморбидной патологией, из них с СД 20 % больных; ХОБЛ выявлена у 22 % пациентов, а АО отмечалось у 44 % пациентов, 6 % заболевания щитовидной железы. Установлено, что недостаточно приверженными (ПТ) были 15,2 % больных, не привержены к терапии (НПТ) — 37,2 %, а ПТ к терапии оказались только 47,8 % опрошенных. Определено, что длительность АГ не являлась значимой мотивацией, поскольку в группе НПТ отмечалась значимо большая длительность АГ по сравнению с группой ПТ (12,3 vs 10,5 лет; p < 0,03); при оценке приверженности в зависимости от формы ФП оказалось, что пациенты с постоянной формой ФП были более ПТ (р = 0,001), а при сравнительном анализе между клиническими группами, в зависимости от экстракардиальных заболеваний, не было выявлено статистически значимых различий. Сравнительный анализ пациентов НПТ и ПТ показал, что наибольшее применение имеют блокаторы ренин-ангиотензин-альдостероновой системы (РААС) — до 66 %, при оценке использования фиксированных комбинаций (ФК) периндоприла (ФК индапамида/периндоприла и ФК амлодипина/индапамида/периндоприла) оказалось, что ПТ пациенты значимо чаще принимали их (р =0,003; р = 0,01). На основании проведенного анализа установлено, что наличие семьи, высшего образования, уровень доходов, мотивация и доверие врачам являются значимыми факторами, повышающими приверженность лечению. Заключение. Главной причиной низкой приверженности, по результатам нашего исследования, явилась полипрагмазия, которая связана с применением большого количества препаратов и сложных схем лечения. Таким образом, ограничение применения ФК является одной из главных причин недостаточной приверженности и требует скорого решения.

Objective. To evaluate adherence to therapy in patients with hypertension (HTN) and atrial fibrillation (AF) in combination with extracardiac comorbid pathology. Design and methods. In an observational cohort study, 884 patients aged 45–65 years with AF (paroxysmal and persistent form) and HTN were observed, in combination with extracardiac comorbid diseases: diabetes mellitus (DM), n = 123; abdominal obesity (AO), n = 171; chronic obstructive pulmonary disease (COPD), n = 137, hypothyroidism, n = 156; thyrotoxicosis, n = 112. The comparison group consisted of 185 patients with AF and HTN, without concomitant extracardiac pathology. Clinical, anthropometric parameters, the Morischi–Green adherence test were evaluated in the work. To assess the social aspects of low adherence, special questionnaires were developed. All statistical calculations were performed using the Rstudio program. Results. Among patients with AF and HTN, 66 % had concomitant extracardiac comorbid pathology, 20 % of them with DM; COPD was detected in 22 % of patients, and AO was observed in 44 % of patients, 6 % patients had thyroid disease. 15,2 % patients were insufficiently adherent (ADH), 37,2 % were not adherent to therapy (NADH), and only 47,8 % respondents were adherent to therapy. The duration of HTN was not a significant motivation for adherence, because the NADH group had a significantly longer duration of arterial hypertension compared with the ADH group (12.3 vs 10.5 years; p < 0.03); patients with the permanent form of AF were more than ADH (p = 0,001), and the adherence did not differ between groups depending on extracardiac diseases. The blockers of the renin-angiotensin-aldosterone system showed the greatest use — up to 66 %, while adherent patients were more likely to take single-pill combination (SPC) of perindopril (SPC indapamide/perindopril and SPC amlodipine/indapamide/perindopril) (p = 0,003; p = 0,01). Based on the analysis, it was found that the presence of a family, higher education, income level, motivation and trust in doctors are significant factors that increase adherence to treatment. Conclusions. The problem of non-commitment has been and remains one of the most complex and difficult to solve. The main reason for low adherence among patients with AF with concomitant extracardiac diseases was polypharmacy, and it is associated with the use of a large number of drugs and a complex treatment regimen. Thus, the limitation of the use of fixed combinations is one of the main reasons for the lack of adherence and needs to be addressed soon.

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The authors declare that there are no conflicts of interest present.