Effect of patient compliance on management of hypertension and high blood lipids in cardiac patients

Arterijska hipertenzija, od svih čimbenika rizika za razvoj kardiovaskularnih bolesti, ima najvišu prevalenciju (37,50%) u Republici Hrvatskoj. Specifični mortalitet od komplikacija kardiovaskularnih bolesti iznosi 34,94% ukupnog mortaliteta. Kako bismo smanjili komplikacije težimo postizanju ciljnih vrijednosti krvnog tlaka ispod 140/90 mmHg. Ipak, 42,18% srčanih bolesnika s arterijskom hipertenzijom ne postiže ciljane vrijednosti krvnog tlaka usprkos antihipertenzivnoj terapiji od najmanje tri antihipertenziva u adekvatnoj dozi, od kojih je jedan diuretik. Među najčešćim uzrocima terapijskog neuspjeha je neredovito uzimanje terapije, stoga 13,61% srčanih bolesnika s arterijskom hipertenzijom ne postiže ciljane vrijednosti krvnog tlaka zbog niske suradnje. U ovom presječnom istraživanju koje je trajalo od prosinca 2016. godine do travnja 2017. godine sudjelovala su 154 ambulantna bolesnika Klinike za bolesti srca i krvnih žila Kliničkog bolničkog centra Sestre milosrdnice; 147 s arterijskom hipertenzijom i 120 s dislipidemijom. Za procjenu suradnje pacijenata korištena je Moriskyeva skala s osam pitanja za mjerenje suradnje pacijenata (MMAS-8). Od srčanih bolesnika s arterijskom hipertenzijom 22,45% bilo je nisko suradljivo, a taj postotak ostao je približno jednak (22,50%) kod srčanih bolesnika s dislipidemijom. Uz razinu signifikantnosti od 5%, nisko suradljivi su srčani bolesnici s arterijskom hipertenzijom uz vrijednosti sistoličkog krvnog tlaka iznad 140 mmHg, srčani bolesnici s arterijskom hipertenzijom i dislipidemijom uz vrijednosti sistoličkog krvnog tlaka iznad 140mmHg te srčani bolesnici s rezistentnom hipertenzijom. Kod srčanih bolesnika s dislipidemijom nisko suradljive su bolesnice, kao i bolesnici s vrijednostima plazmatskog kolesterola iznad 4,5 mmol/L. Nisko suradljivi pacijenti su srčani bolesnici s arterijskom hipertenzijom koji ne vide dugoročnu korisnost uzimanja antihipertenzivne terapije. Cjeloživotna edukacija te partnerski odnos između pacijenta i liječnika doprinose visokoj suradnji.Arterial hypertension has the largest prevalence (37.50%) in Croatia among all cardiovascular disease risk factors. The specific mortality from complications of cardiovascular diseases amounts 39.94% of the general mortality, therefore we aim at blood pressure values below 140/90 mmHg. Nevertheless, 42.18% of cardiac patients with arterial hypertension do not achieve target blood pressure values in spite of taking at least three antihypertensive medications at an adequate dosage, of which one is a diuretic. Among the most common causes of therapeutic failure is lack of patient compliance. Consequently 13.61% of cardiac patients with arterial hypertension do not achieve the target blood pressure values. This cross-sectional study was conducted in the Clinic for Cardiovascular Diseases, University Hospital Centre Sisters of Charity, from December 2016 to April 2017, and included 154 cardiac patients; 147 with arterial hypertension and 120 with dyslipidemia. To evaluate patient compliance the 8-item Morisky Medication Adherence Scale (MMAS-8), a structured self-report measure of medication-taking behavior, was administered. Regarding cardiac patients with arterial hypertension, 22.45% were poorly adherent and that percentage was approximately the same (22.50%) in cardiac patients with dyslipidemia. With a statistical significance lower than 5%, we can deduct that the ones poorly adherent are cardiac patients with arterial hypertension and systolic blood pressure values greater than 140 mmHg, cardiac patients with arterial hypertension and dyslipidemia and systolic blood pressure values greater than 140 mmHg, as well as cardiac patients with resistant hypertension. When we talk about cardiac patients with dyslipidemia, female patients are more poorly adherent than male, and so are patients with plasma cholesterol levels greater than 4.5 mmol/L. Cardiac patients with arterial hypertension who may not be aware of the longterm benefits of antihypertensive therapy are poorly adherent. Therefore, lifelong learninig and partnership in making decisions contributes to good patient compliance