Resistant hypertension: patient adherence to treatment in outpatient settings

Introduction. Arterial hypertension is one of the main risk factors for developing fatal cardiovascular complications. Among patients with arterial hypertension, there is a subgroup with therapy-resistant hypertension (RH). Resistant arterial hypertension (RAH) is associated with a 2-6-fold increase in the risk of cardiovascular complications, making the problem of its diagnosis and treatment highly relevant.

Aim. To assess patient adherence to treatment for resistant hypertension conducted in outpatient settings.

Materials and methods. A retrospective analysis of outpatient records of patients with hypertension (n=3 321) was carried out, with observations conducted in 5 polyclinic institutions in the city of Aktobe. A group of patients (n=346) with poorly controlled grade 2-3 hypertension was identified and classified into the RAH group. The effectiveness of combination therapy and adherence to the most used antihypertensive drugs were analyzed.

Results and discussion. Combinations of antihypertensive drugs included in triple therapy did not produce effective results. It was noted that 21.4% of prescriptions consisted of an ACE inhibitor and a betablocker + diuretic combination, and 12.7% of cases involved an angiotensin II receptor antagonist (ARA II) + beta-blocker + diuretic. These combinations are no longer considered first-line antihypertensive drug combinations.

Conclusion. The study revealed that the addition of spironolactone to the drug combination led to additional blood pressure reduction in patients with resistant hypertension, thus contributing to improved patient compliance and a more favorable disease course, reducing the risk of frequent complications such as coronary artery disease, acute and chronic brain damage, and kidney disease.

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