Marina Sharayeva, MD, PhD Ukrainian Strazhesko Institute of Cardiology, Department of Pharmacotherapy, Kyiv, Ukraine

Current problems of antihypertensive treatment

Choosing antihypertensive drugs ( AD) forced to follow current guidelines that driven primarily by evidence of efficacy and safety. The goal of antihypertensive treatment is to reduce both BP and other risk factors for cardiovascular disease. There are currently available six major classes of AD that are equally effective in reducing high BP. The initial AD should consider patient risk-factor profile and co-morbidity, as well as the safety and tolerability profile of the drug. When these factors are considered, an effective and well-tolerated drug regimen can be tailored to an individual patient. An initial drug regimen should consist of a low dose of a long-acting, once-daily drug that is titrated upward if BP is not adequately controlled. Low-dose combinations of two AD may also be considered. Results from comparative studies with different classes of AD suggest that different populations of patients, such as those with diabetes, left-ventricular dysfunction, or lipid disorders, may benefit from taking different AD.

Despite the large number of AD available, their usefulness is limited due to low efficacy, side effects, poor patient compliance(C) and failure to reduce the cardiovascular risk outcomes to the level of the general population. Side effects of the main classes of cardiovascular drugs are well-known, dose-depended due to hypotensive activity. Hypertensive patients (HP) are generally unwilling to endure even minor side effects in return for potential benefits (symptoms such as cold perigpheries, tiredness and sleepiness are only of minimal acceptability).

Less then one half of HP adheres to prescribed medications, and fewer than one in three patients have controlled BP. C is difficult to measure, so poor adherence to treatment remains largely undiagnosed in clinical practice and often incorrectly interpreted as a lack of response to treatment. Long-acting AD that provide good BP control beyond the 24-h dosing period should perhaps be considered as drugs of choice in non-compliant HP because they help to prevent the consequences of occasional drug omissions.

BP control with the level of adherence to AD and factors influencing C were studied in HP. W e evaluated adherence to treatment in terms of persistence during the year (patients were defined persistent if they received at least one prescription per year) and in terms of daily coverage (an amount of drugs consistent with a daily treatment), switches or addition of other agents were identified. Patients were interviewed using pre-coded questionnaires with questions on demographic data, health and treatment status. C was defined as an affirmative reply to a number of questions regarding regular use of antihypertensive medication according to the physician's instructions. Satisfactory BP control (levels <140/90 mmHg) was documented in only 20% of the treated hypertensives. C to antihypertensive treatment was found in only 15% of the patients. Control of BP was positively associated with C, more common among patients aged <60, female, city dwellers, the better educated, those more adequately counselled by their physicians. C was better among those taking one antihypertensive tablet per day, those who had never changed their antihypertensive regimen and those who had never changed their doctor.