Objective: To study the problems of physician-patient cooperation, patient- and physician related barrieres to target blood pressure (BP) achievement and to demonstrate improvement of BP control with indapamide SR 1.5 mg, when given to patients remaining uncontrolled while receiving antihypertensive therapy without thiazide diuretics (TD).
Methods: The trial Improvement of Arterial Hypertension Control in High-Risk Hypertensive Patients (ARGUS-2) run in 15 Russian centres during the year 2006. Retrospective analysis of medical notes of 684 outpatients and 575 inpatients with arterial hypertension. Validated questionnaires were used for interview of 373 physicians and 1298 patients. The study of Arifon retard efficacy was carried out in 1438 outpatients with difficult-to-control hypertension.
Results: BP was above the goal level in 97.1% pts at the first analyzed visit to an outpatient department. Antihypertensive therapy was unchanged in 20.5% cases, the drug dose was increased in 46,6%, additional medication was administered in 36,8%. In 30.8% pts antihypertensive agent was substituted by another class drug. At the last analyzed visit target BP was found in 24.4% pts. BP control was poorer in pts with BP goal <130/80 mmHg (20.1%) than in those with higher target BP (25.9%). Achievement of BP goal was associated with combination therapy, higher rate of TD administration and with more frequent visits to physician. During hospitalization target BP <140/<90 mmHg was achieved in 87.1%,<130/<80 mmHg in. 76.2%. Arifon retard administration resulted in target BO achievement in 84.5% patients. Physicians percept low adherence to antihypertensive treatment, lack of patients knowledge about risk related to arterial hypertension, economical problems as main barriers to improvement of arterial hypertension management. Patients considered economical problems related to antihypertensive treatment more much less important than physicians did.
Conclusion: The study results suggest the importance of therapeutic inertia overcome to improve arterial hypertension management in Russia. Low rate of multiple combination therapy and TD prescription are important features of therapeutic inertia. Polar perception of problems related to arterial hypertension by physicians and patients should be considered as influencing factors for educational programs development.