Estimation of adherence to treatment among patients with arterial hypertension based on therapeutic drug monitoring data

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Abstract

One of the possible reasons for the ineffectiveness of arterial hypertension therapy is a low patients’ adherence to treatment.

The aim: to determine patient adherence to antihypertensive therapy using therapeutic drug monitoring (TDM) and compare the obtained data with the results of adherence estimation using the Questionnaire for Quantitative Estimation of Adherence to Treatment.

Material and methods. A clinical, cross-sectional, controlled study was performed at regional clinical cardiology dispensary (Ryazan). It included patients over 18 years of age with proven diagnosis of arterial hypertension. The level of blood pressure (BP) was fixed according to the data of daily blood pressure monitoring (DBPM). Adherence to treatment was assessed using the Questionnaire for Quantitative Estimation of Adherence to Treatment and determination of the concentration of metoprolol, lisinopril, amlodipine, valsartan and indapamide in the blood serum (TDM).

Results. The study included 183 individuals (78 male and 105 female patients, their average age was 63.4 ± 11.1 years). Uncontrolled hypertension group included 98 patients. Control criteria were the target values of average systolic, diastolic BP during the day and at night according to DBPM results. According to TDM data, the majority of patients had high adherence – more than 80%. Statistically significant differences were noted in the uncontrolled and controlled hypertension groups in the frequency of average adherence to lisinopril therapy. According to the data of the Questionnaire for Quantitative Estimation of Adherence to Treatment, the frequency of high adherence to treatment averaged 21.3% and did not differ in the uncontrolled and controlled hypertension groups. When comparing the results according to the Questionnaire for Quantitative Estimation of Adherence to Treatment and TDM data, coincidence was observed in less than a quarter of cases.

Conclusion. The results of assessing patients’ adherence to treatment using serum drug concentration monitoring coincide with the data of the Questionnaire for Quantitative Estimation of Adherence to Treatment in less than a quarter of cases in case of controlled arterial hypertension (10.0–26.7%), which is slightly higher than in case of uncontrolled hypertension (9.1–16.7%).

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About the authors

Sergey V. Seleznev

Academician I.P. Pavlov Ryazan State Medical University of the Ministry of Healthcare of Russia

Author for correspondence.
Email: sv.seleznev@gmail.com
ORCID iD: 0000-0002-4069-8082

MD, PhD (Medicine), associate professor, associate professor of the Department of hospital therapy with the course of medical and social expertise

Russian Federation, 390026, Ryazan, 96 Stroykova St.

Pavel Yu. Mylnikov

Academician I.P. Pavlov Ryazan State Medical University of the Ministry of Healthcare of Russia

Email: dukeviperlr@gmail.com
ORCID iD: 0000-0001-7829-2494

MD, PhD (Biology), associate professor of the Department of pharmacology

Russian Federation, 390026, Ryazan, 96 Stroykova St.

Allexey V. Shchulkin

Academician I.P. Pavlov Ryazan State Medical University of the Ministry of Healthcare of Russia

Email: alekseyshulkin@rambler.ru
ORCID iD: 0000-0003-1688-0017

MD, Dr. Sci. (Medicine), associate professor, professor of the Department of pharmacology

Russian Federation, 390026, Ryazan, 96 Stroykova St.

Sergey S. Yakushin

Academician I.P. Pavlov Ryazan State Medical University of the Ministry of Healthcare of Russia

Email: prof.yakushin@gmail.com
ORCID iD: 0000-0002-1394-3791

MD, Dr. Sci. (Medicine), professor, head of the Department of hospital therapy with a course in medical and social expertise

Russian Federation, 390026, Ryazan, 96 Stroykova St.

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