Antihypertensive therapy features in multimorbid outpatients

Objective. To assess the characteristics of antihypertensive therapy (AHT) in outpatient patients in relation to comorbidities and multimorbidity level.
Design and methods. A cross-sectional study included 140 patients with diagnosed hypertension (HTN). We performed a standardized complaints and medical history registration, questionnaire survey, anthropometry, office blood pressure (BP) assessment. Based on Charlson index the patients were divided into 2 groups: group 1 with moderate multimorbidity (≤ 4 points), group 2 with high multimorbidity level (≥ 5 points). The data are presented as median and proportions with bi-directional 95 % confidence interval.
Results. In the sampling of 100 (_64,3 71,4 _78,6 %) women and 40 (_21,4 28,6 _35,7 %) men median age was ₆₅ 68 ₇₀, median Charlson index was ₄ 5 ₅. Group with moderate multimorbidity included 63 patients. High multimorbidity group included 77 subjects. HTN degree did not differ between the groups. Subjects from group 2 had higher level of cardiovascular risk (χ² = 17,2, df = 2, p = 0,00018) and were more likely to have a history of HTN-associated clinical conditions (χ² = 27,1, df = 2, p = 0,00000). By the time of examination, AHT was started in 137 (_95,097,9 _100,0%) patients. Monotherapy was ongoing in 20 cases (8,814,3 20,4%), combined AHT was prescribed to 117 (_79,6 85,4 _91,2 %) persons: 50 (_21,2 36,5 _43,8 %) patients received 2 drugs, 67 (_40,9 48,9 _56,9 %) patients received ≥ drugs. Number of antihypertensive drugs was higher in patients of group 2 than in group 1 (χ² = 6,7, df = 2, p = 0,036). Drug number was not associated with HTN degree (χ² = 3,8, df = 4, p = 0,44). Patients from group 2 were more likely to take β₁-blockers (p = 0,027) and moxonidine (p = 0,042). Non-steroid anti-inflammatory drugs (NSAIDs) reduced the frequency of achieving the target BP level in patients treated by angiotensin converting enzyme inhibitors (p = 0,002). The frequency of achieving target BP was _42,9 50,7 _58,6 %, it was independent of the number of prescribed drugs (p = 0,07) and did not differ in the groups of moderate and high multimorbidity (p = 0,87).
Conclusions. Multimorbid patients require combined antihypertensive drugs to control hypertension. Multimorbidity level, comorbidities and drug-to-drug interactions should be taken into account during individualized HTN management. NSAID significantly affect the effectiveness of antihypertensive therapy.

1. Oganov RV, Simanenkov VI, Bakulin IG, Bakulina NV, Barbarash OL, Boitsov SA et al. Comorbid pathology in clinical practice. Diagnostic and treatment algorithms. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prophylaxis. 2019; 18 (1): 5-66. In Russian. doi: 10.15829/1728-8800-2019-1-5-66.

2. Charlson ME et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of chronic diseases. 1987; 40(5): 373-83.

3. Chazova IE, Zhernakova YuV on behalf of experts. Arterial hypertension diagnostics and treatment. Clinical recommendations. Sistemnye gipertenzii = System Hypertensions. 2019; 1: 6-31. In Russian. doi: 10.26442/2075082X.2019.1.190179.

4. Leonova MV, Belousov YuB, Shteinberg LL, Galitskii AA, Belousov DYu. Arterial hypertension patients treatment features (in “PIFAGOR III” clinic trial results). Arterial'naya gipertenziya = Arterial hypertension. 2010; 16(5): 485-92. In Russian.

5. Leonova MV, Shteinberg LL, Belousov YuB, Belyavskaya DV, Vydrina OI, Pasternak EYu et al. Arterial hypertension pharmacoepidemiological study “PIFAGOR IV” results: doctors commitment. Rossiiskii kardiologicheskii zhurnal = Russian Cardiology Journal. 2015; 1(117): 59-66. In Russian. doi: 10.15829/1560-4071-2015-1-59-66.

6. Arutyunov GP, Nedogoda SV, Gilyarevskiy SR, Baranova EI, Drapkina OM, Konradi AO. Challenging problems of hypertension management: the effect of increased heart rate and comorbidities on the choice of antihypertensive therapy in practice of cardiologist and therapist. The Conclusion of the Expert Council. Ratsional'naya farmakoterapiya v kardiologii = Ration Pharmacother Cardiol. 2015; 11(1): 63-67. In Russian.

7. Nedogoda SV, Sabanov AV. Target blood pressure achievement in arterial hypertension patients on the anti-hypertensive therapy background in real clinic practice. Rossiiskii kardiologicheskii zhurnal = Russian Cardiology Journal. 2018; 23(11): 100-9. In Russian. doi: 10.15829/1560-4071-2018-11-100-109.

8. Shal'nova SA, Deev AD, Balanova YuA, Zhernakova YuV, Konradi AO, Boitsov SA. Treatment of hypertension in high-risk patients. Monotherapy or combination? Lechashchii vrach = Attending Doctor. 2016; 7: 17. In Russian.

9. Rodionov AV. Non-steroid anti-inflammatory drugs and arterial hypertension: problem relevance and patients management tactics. Lechashchii vrach = Attending Doctor. 2013; 2: 25-31. In Russian.

10. Karateev AE, Nasonov EL, Ivashkin VT, Yakhno NN, Chichasova NV, Alekseeva LI et al. Clinical recommendations “Non-steroid anti-inflammatory drugs (NSAID) rational using in clinical practice”. Sovremennaya revmatologiya = Modern Rheumatology. 2015; 9(1): 4-23. In Russian. doi: 10.14412/1996-7012-2015-1-4-23.

11. Cheng HF, Harris RC. Cyclooxygenases, the Kidney, and Hypertension. Hypertension. 2004: 43(3): 525-30. doi: 10.1161/01.HYP.0000116221.27079.ea.

12. Konradi AO. Arterial hypertension treatment main problems in comorbid patients. Serdtse: zhurnal dlya praktikuyushchikh vrachei = Russian Heart Journal. 2010; 1(51): 37-41. In Russian.

13. Karateev AE, Lila AM, Churyukanov MV, Skorobogatykh KV, Amelin AV, Zakharov DV et al. Non-steroid anti-inflammatory drugs (NSAIDs) prescription algorithm efficacy evaluation based on drug complications risk factors analysis in current practice. All-Russian project “PRINCIP” (NSAIDs using recommendations application: purposeful practice changing. Nauchno-prakticheskaya revmatologiya = Scientific and practical Rheumatology. 2017; 55(5): 485–92. In Russian. doi: 10.14412/1995-4484-2017-485-492.

14. Mikhailov AA, Shilov AM, Spasskii AA. Drug “Physiotens” using domestic and foreign experience in “civilization diseases” treatment. Arkhiv vnutrennei meditsiny = Archive of Internal Medicine. 2012; 1(3): 41-5. In Russian.

15. Nedogoda SV. Combination of ace inhibitor with agonist of I1-imidazoline receptors: new opportunities for antihypertensive therapy. Rossiiskii kardiologicheskii zhurnal = Russian Cardiology Journal. 2016; 12 (140): 103-8. In Russian. doi: 10.15829/1560-4071-2016-12-103-108.

16. Sharma AM, Wagner T, Marsalek P. Moxonidine in the treatment of overweight and obese patients with the metabolic syndrome: a postmarketing surveillance study. J Hum Hypertens. 2004 Sep; 18 (9): 669-75. doi: 10.1038/sj.jhh.1001676.

17. Chesnikova AI, Safronenko VA, Skarzhinskaya NS, Safronenko AV, Kolomatskaya OE. Arterial hypertension features in comorbid patients. Meditsinskii vestnik Yuga Rossii = Russian South Medical Messenger. 2017; 1(8): 32-8. In Russian.