Efficacy of an optimized therapeutic training during the correction of modifiable risk factors among hypertensive smokers

Background and objective. The strategy aimed at overall cardiovascular risk reduction involves the assessment of patient’s personality and motivating him/her to change his/her lifestyle. Poor medication adherence and coping behavior of smokers with hypertension (HTN) indicate the need for improvements in therapeutic training and including into the training program both information on stress and the information related to stress coping behavior. The purpose of the study was the assessment of the efficacy of an optimized therapeutic training during the correction of modifiable risk factors among HTN smokers. Design and methods. We surveyed 102 male smokers with HTN; among them 52 male smokers with HTN (mean age 48,5 ± 1,05 years, disease duration of 7,9 ± 0,52 years and smoking history of 18,0 ± 1,16 years) attended an optimized program of the School for Patients with HTN, and 50 male smokers with HTN (mean age 49,7 ± 1,04 years, disease duration of 7,6 ± 0,47 years and smoking history of 19,2 ± 0,85 years) attended a standard structured program of the School for Patients with HTN. The enhancement of the training program of the School for Patients with HTN consisted in perfoming a person-oriented training at this School and introducing a modified stress coping skills training course. Results. The efficacy of the optimized therapeutic training of male smokers with HTN was determined. We found a number of advantages of the enhanced therapeutic training over the standard structured training with respect to the correction of modifiable risk factors among smokers with HTN. The optimized therapeutic training helps to maintain target blood pressure level, to reduce smoking intensity, to reduce the levels of nicotine dependence and triglyceride concentrations, as well as to extend the range of coping behavior strategies. Conclusions. The introduction of a modified stress coping skills training course and a person-centred model of therapeutic training in the program of the therapeutic training of smokers with HTN improves the efficiency of the correction of modifiable risk factors.

1. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34 (28):2159–2219. doi:10.1093/eurheartj/eht151

2. Mancia G, De Backer G, Dominiczak А, Cifkova R, Fagard R, Germano G et al. Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25 (6):1105–1188.

3. School of health: arterial hypertension. Ed. by R. G. Oganov. Moscow: GEOTAR-Media, 2008. 188 p. In Russian

4. Global Health Risks. Mortality and burden of disease attributable to selected major risks. World Health Organization. Geneva, 2009. 39 p.

5. Eller NH, Netterstrom B, Gyntelberg F, Kristensen TS, Nielsen F, Steptoe A et al. Work-related psychosocial factors and the development of ischemic heart disease: a systematic review. Cardiol Rev. 2009;17(2):83–97.

6. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37 (29):2315–2381. doi:10.1093/eurheartj/ehw106

7. Gadayev AG, Gulyamova ShS. Evaluating the effectiveness of work of a school for the hypertensive patient at the level of primary health care. Profilakticheskaya Meditsina = Preventive Medicine. 2012;2(3):7–15. In Russian

8. Kontsevaya AV, Kalinin AM, Spivak EJ. Social and economic efficiency of the «schools of health» for patients with cardiovascular diseases. Profilaktika Zabolevaniy i Ukrepleniye Zdorovya = Prevention and Health Promotion. 2008;2:3–8. In Russian

9. European guidelines on cardiovascular disease prevention in clinical practice (Review 2012). Rossiyskiy Kardio- logicheskiy Zhurnal = Russian Journal of Cardiology. 2012;96(4), Suppl 2:1–84. In Russian

10. Oganov RG, Pogosova GV, Koltunov IE, Belova YuS, Vygodin VA. RELIEF — Regular Treatment and Prevention — the key to improvement of situation with cardiovascular diseases in Russia: results of a Russian Multicenter Study (Part I). Kardiologiia. 2007;5:58–66. In Russian

11. Bursikov A. V., Manyugina E. A. The features and smoking behaviour and nicotine dependence in men suffering from arterial hypertension and ischemic heart disease in combination with arterial hypertension. Arterialnaya Gipertenziya= Arterial Hypertension. 2010;16(6):599–603. In Russian

12. Manyugina E. A., Bursikov A. V., Shvager O. V. The role of coping behavior for the attitude to the disease in hypertensive smokers. Arterialnaya Gipertenziya= Arterial Hypertension. 2014;20(4):280– 287. In Russian

13. Kalinina AM, Oganov RG, Nebieridze DV. Patients’ education as a factor for arterial hypertension effective control — NOCTURNE Program. Kardiovaskulyarnaya Terapiya i Profilaktika = Cardiovascular Therapy and Prevention. 2006;5(3):5–14. In Russian

14. Ushakova SE, Shutemova EA, Kodryanu LI, Kontsevaya AV, Nazarova OA, Kalinina AM. Effectiveness of various methods for therapeutic training of patients with arterial hypertension. Profilakticheskaya Meditsina = Preventive Medicine. 2006;2:40–48. In Russian

15. Yakimanskaya IS. Development of the technology of person-oriented teaching. Voprosy Psikhologii = Issues of Psychology. 1995;2:31–41. In Russian

16. Fagerstrom KO, Tejding R, Westin A, Lunnell L. Nicotine replacement present and future. Tob Control. 1997;6(4):311–316.

17. Fetiskin NP, Kozlov VV, Manuilov GM. The coping behaviour in stress situations (Norman S, Endler DF, Jamys DA, Parker MI, adapted by Kryukova TA). Social and psychological diagnostics of personality development and small groups. Moscow, 2002. 442–444 p. In Russian

18. Barton C, Clarke D, Sulaiman N, Abramson M. Coping as a mediator of psychosocial impediments to optimal management and control of asthma. Respiratory Medicine. 2003;97(7):747–761.

19. Vitaliano PP, Russo J, Niaura R. Plasma lipids and their relationships with psychosocial factors in older adults. J Gerontol B Psychol Sci Soc Sci. 1995;50(1):18–24.

20. Bursikov AV., Manyugina EA. Mechanisms of psychological protection and types of attitude to the disease in men with arterial hypertension. Vestnik Ivanovskoj medicinskoj akademii = Bulletin of the Ivanovo Medical Academy. 2010;15(2):48–49. In Russian

21. Svetlakova VP. Choice of cognitively-induced coping mechanisms. Psikhopedagogika v Pravookhranitelnykh Organakh = Psychopedagogy in Law-enforcement. 2009;38(3):43–46. In Russian