Adherence to Treatment and Factors Influencing the Quality of Treatment of Hypertension in Patients in the Long Term After Myocardial Infarction

Introduction. Adherence to the treatment of arterial hypertension (AH) after myocardial infarction (MI) remains an understudied problem in world cardiology.

The aim of the study. Assess adherence to treatment and the factors that affect it in patients with AH in the remote period after MI.

Materials and methods. The study included 265 patients after MI (68.2 % of men, mean age 65.4 ± 9.5 years). The mean time from MI to inclusion in the study was 2.3 ± 1.9 years. Assessment of the quality of secondary prevention was performed by analyzing the results of the questionnaire, measuring of anthropometric parameters, blood pressure (BP) and heart rate (HR), as well as determining lipid metabolism, creatinine and venous blood glucose.

Results. The frequency of detection of AH in the long period after MI is 69.1 %, regardless of gender, time of MI and its variant and increases in proportion to age. Only in 26.3 % of patients with hypertension in the remote period after MI BP was within the target values. Factors associated with achieving the target values of BP were age up to 60 years (OR – 1.35; p = 0.02), a visit to the doctor during the last 6 months (OR – 1.82; p = 0.002), regular independent blood pressure measurement (OR – 1.63; p = 0.01). 13.3 % of patients with AH after MI did not take antihypertensive drugs, the remaining 60.4 % of patients with AH were treated but did not reach the target BP. Among patients with AH after MI who did not take antihypertensive drugs, patients older than 60 years prevailed (83.3 % vs. 63.2 % of treated patients, p = 0.05). In addition, much less often these patients were under the supervision of a doctor – 47.4 % vs. 82.8 % (p = 0.0005), including a cardiologist (40.9 % vs. 75.0 %, p = 0.001), less visited a doctor for a year, had lower BP, and had poorer knowledge of post-MI treatment. In addition, none of them use statins. Patients with AH who received treatment but did not reach the target BP values received the same amount of antihypertensive drugs as patients with controlled AH – an average of 2.1 ± 1.0 and 2.1 ± 0.9 drugs, respectively. At the same time, 29.3 % of patients in the group of ineffectively treated AH received monotherapy. No differences were found between age, sex, basic clinical and social parameters, financial status, health knowledge, self-measurement of blood pressure, or frequency of physician visits.

Conclusions. To achieve the target BP levels in patients with AH after MI, it is necessary to: introduce regular measurement of home BP in all patients; use combination antihypertensive therapy, including, if necessary, with the use of three or more drugs; regularly monitor adherence to treatment, use of antiplatelet, antihypertensive drugs and statins. Patients with difficult-to-control AH should consult a cardiologist at least every 6 months.