[Adherence to Therapy in the Outpatient Setting: the Ability to Identify and Assess the Effectiveness of Therapy].

AIM: To assess adherence of patients to antihypertensive therapy, to determine the role of various factors affecting adherence to treatment by outpatients, and to assess clinical efficacy of a calcium antagonist felodipine.

MATERIAL AND METHODS: We examined 5 474 women and men aged >18 years who at visit to a local internist had office systolic arterial pressure (AP) 140-179 and diastolic AP up to 100 mm Hg both on and without hypotensive therapy. Examination included registration of risk factors and concomitant therapy. All patients self-assessed their state of heath using visual analog scale (VAS). Adherence to therapy was evaluated by the Morisky-Green test. Obtaining by a patient of antihypertensive drugs in the framework of the Programme for Supplementary Pharmaceutical Provision (SPP) was necessarily registered.

RESULTS: Among examined ambulatory patients with arterial hypertension (AH) and ischemic heart disease (IHD) more than 60% had low adherence to prescribed medications. Such factors as complicated AH course when AH was combined with IHD or diabetes (D), use of angiotensin converting enzyme inhibitors, calcium antagonists, and angiotensin receptor blockers were associated with high adherence to treatment. Male sex, elderly age, presence of risk factors of cardiovascular complications, and long history of AH were associated with low adherence to therapy. Presence of prescribed drugs in the SSP list was associated with high adherence but multifactorial analysis with inclusion of IHD, D, availability of a tonometer at home made contribution of SSP in high adherence insignificant. The use of felodipine allowed not only to achieve pronounced hypotensive effect in patients with AH but also to improve initially low adherence.

CONCLUSION: During long-term observation of outpatients, it is necessary to regularly assess possibly low adherence to therapy with the aim of its improvement.