Low Adherence of Hypertension Patients to Treatment –

What Is To Be Done? Clinical Problem for Public Health

Alexander V. Sergeev, MD, PhD, MPH

Irina B. Bazina, MD, PhD

Smolensk State Medical Academy

Smolensk, Russia

Hypertension: is it really dangerous?Hypertension: is it really dangerous?

• People don’t die of hypertension itself, but …

they die of its complications• Target organ damage (heart, brain,

kidneys) • CHD and stroke are causes of disability

and death

Hypertension & Public HealthHypertension & Public Health

• High prevalence burden from public health perspective

• BP over 140/90 in over 1/3 of adult population

• Particular concern: high prevalence among workforce

Hypertension: actual problem for RussiaHypertension: actual problem for Russia

• Rise in mortality from the major complications of hypertension – CHD and stroke – during the last 20 years

• High prevalence among workforce • Early disability; decreased life

expectancy

The problem of hypertension patients’ low The problem of hypertension patients’ low compliance to therapycompliance to therapy

• Low percentage of those who take medications regularly and have their BP controlled effectively

• Decrease in compliance among males as compared to 1980s

• Patients’ attitude to their health• Low priority of health on one’s values scale • Being inadequately informed of disease

The result is sad: Irregular treatment cannot stabilize BP at safe level

ObjectiveObjective

• To analyze the factors associated with low adherence of hypertension patients to treatment

• To work out recommendations on development of population level approaches to solving the problem of low adherence from public health perspective

MethodsMethods

• Study design: cross-sectional study• Study population: essential hypertension

(stages I-III) patients of young age (22-45 yrs old)

• Catchment area: employees of organizations located in Smolensk Oblast

• N=224• Questionnaire: questions pertaining to

knowledge of hypertension and attitude to various aspects of the disease including the necessity of treatment

Statistical AnalysisStatistical Analysis

• Binary outcome variable• Probability of getting negative answer to the

question: “Do you think that hypertension patients should be on permanent treatment?”

• Multiple logistic regression – simultaneous control for a number of factors influencing binary outcome variable

• SAS software, PROC GENMOD

““Do you think that hypertension patients Do you think that hypertension patients should be on permanent treatment?”should be on permanent treatment?”

• 101 (45.09%) patients gave negative answer

Factors associated with hypertension patients’ Factors associated with hypertension patients’ noncompliance/compliance to treatmentnoncompliance/compliance to treatment

Model parameters OR 95% CI

Male (vs. female) gender 1.623 (0.722, 3.651)

Age (vs. 22-30 yrs)

31-40 yrs 1.213 (0.552, 2.665)

40-45 yrs 1.085 (0.487, 2.417)

Duration of disease (vs. <1 yr)

1-3 yrs 0.298 (0.128, 0.696)

>3 yrs 0.190 (0.080, 0.453)

Presence (vs. absence) of the clinical sequelae of hypertension

0.292 (0.162, 0.526)

Low adherence risk groupLow adherence risk group

• Short length of disease

• No clinical sequelae of hypertension (asymptomatic patients)

What can be expected of risk group?What can be expected of risk group?

• Behavioral pattern and peculiarities of self-perception of the disease

• Anosognosic attitude to the disease

“I feel OK even when my blood pressure is 180/110. And 170/100 is my usual BP. So, there is no need for treatment, and I am not going to see the doctor!”

Health Belief ModelHealth Belief Model

• Patient: subjective perception of health status and disease severity

• Physician: objective assessment

Who is right?

What can be done to improve the What can be done to improve the situation?situation?

• Low effectiveness of individual level influences

• Need for population level influences

• Information campaigns analogous to social advertising

The cost of the medicine and adherence: The cost of the medicine and adherence: myths and realitiesmyths and realities

• Cost is not a major determinant • Free medications cannot guarantee

adequate adherence

Physicians and public health professionals Physicians and public health professionals against low compliance – against low compliance – who should be the leader?who should be the leader?

• Interdisciplinary task

• Public health professionals’ competence in population level influences

Thank you!Thank you!