Шляхи корекції асоційованого метаболічного синдрому у хворих на гіпертонічну хворобу

Abstract

Використання оцінки рівня прихильності в корекції лікування хворих на гіпертонічну хворобу асоційовану з метаболічним синдромом приводить до оптимального гіпотензивного ефекту, позитивної динаміки перебігу МС та підвищення прихильності до лікування, дозволяє знизити частоту серцево-судинних ускладнень, попереджати прогресування поєднаної патології та покращити прогноз захворювання; Использование оценки уровня приверженности в коррекции лечения больных гипертонической болезнью ассоциированной с метаболическим синдромом приводит к оптимальному гипотензивному эффекту, положительной динамики течения МС, повышении приверженности к лечению, позволяет снизить частоту сердечно-сосудистых осложнений, предупреждать прогрессирования сочетанной патологии и улучшить прогноз заболевания; Nowadays the problem of metabolic syndrome (MS) and arterial hypertension (AH) is extremely urgent as cardiovascular pathology and it is one of the leading causes of death and disability in Ukraine as well all over the world. Despite the achievements of medical science, the development and implementation in clinic new drugs and managerial standards for patients with high blood pressure (AP), hypertension disease (HD) holds the leading position among the causes of mortality not only in the world, but also in Ukraine, and morbidity continues to grow steadily. The low commitment of patients to treatment, due to many subjective and objective reasons, is recognized today by the majority of specialists as the most significant barrier for successful treatment of patients with MS. The low compliance patients to treatment is due to many subjective and objective reasons, and it is recognized today by the majority of specialists as the most significant barrier for successful treatment of patients with MS. The purpose of our work was to study the patient compliance and correction of the associated metabolic syndrome treatment of patients with hypertension. Results of research and discussion of them The made researches showed that knowledge about the disease and its complications among patients with hypertension remains insufficient, therefore, many patients underestimate the seriousness of the disease and accordingly do not fully follow the doctor`s recommendations. According to the questionnaire at first it was found that 32.5% of patients with high compliance rates, 25.8% with average compliance and 41.7% with low compliance. At carrying out the Daily Blood Pressure Monitoring it was revealed that patients with hypertension disease associated with MS the increase in blood pressure indicates a reliable excess of average daily blood pressure (AT). High levels of hemodynamic daily load ("load by pressure"), insufficient night pressure decrease, increase of the time index and AH area index are features of the daily profile of AT and it indicates the possibility of early development of heart failure, progression of combined pathology and the risk of complications. In addition, the average indexes of the daily index indicate the prevalence of daytime curves such as non-dippers and night-peakers associated with increase in heart rate 89.5 ± 10.4 a min. The compliance of patients to the treatment was closely related to the level of blood pressure in both at the beginning of the research and the stages of treatment. Patients with high compliance had the lowest levels of systolic and diastolic arterial pressure in all stages of treatment. That means on the one hand, at the beginning of the research the higher affection was at the patients with lower blood pressure, on the other hand, high compliance to treatment could contribute to better control of blood pressure on the background of therapy. Thus, among the people with low compliance level the largest share of the patients, who smoke, was, and they smoked the largest number of cigarettes per a day. The "experience" of smoking was the highest at patients with moderate hypertension, the lowest was at the patients with high level of compliance. Patients who abused with alcohol were most often in the group with a low compliance. During interviewing the history of life, it was found that men were more likely to take alcohol than women (above the mentioned norm) and they all temporarily stopped alcohol abusing for the time of hypertensive crises and their complications (stroke, heart attacks). At carrying out standardization by age, sex, hypertension etiology, duration of hypertension, cardiovascular risk and lifestyle factors (body mass index, smoking, alcohol abuse, education, regular physical activity, salt abuse, consumption of fresh vegetables, presence of work), it was found that independent factors associated with low compliance were older age, male sex, high cardiovascular risk, alcohol and salt abuses, and decreased physical activity. Failure to follow the recommendations results in more frequent development of repeated myocardial infarction and hospitalizations among both men and women. There is tendency to exercise physical activity among women of young and middle age and men of old age. Following the diet is an effective method of secondary prevention of hypertension. According to our results 61% of women and 57% of men do not follow the appropriate diet and do not keep tracking their weight. The prescription of a fixed combination of antihypertensives, the provision of written guidelines for arterial hypertension treatment and keeping a diary led to better results: 57.3% of patients with high compliance rate, 28.1% average compliance rate and 14.6% low compliance rate. The use of such an approach to the choice of therapeutic tactics promotes effective treatment and leads to optimal hypotensive effect, positive dynamics of MS period and increasing compliance to treatment, it allows reducing incidence of cardiovascular complications, prevents the progression of combined pathology and improves the prognosis of the disease.