Abstract
BackgroundChronic diseases like hypertension need comprehensive lifetime management. This study assessed clinical and patient-reported outcomes and compared them by treatment patterns and adherence at 6 months among uncontrolled hypertensive patients in Korea.MethodsThis prospective, observational study was conducted at 16 major hospitals where uncontrolled hypertensive patients receiving anti-hypertension medications (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg) were enrolled during 2015 to 2016 and studied for the following 6 months. A review of medical records was performed to collect data on treatment patterns to determine the presence of guideline-based practice (GBP). GBP was defined as: (1) maximize first medication before adding second or (2) add second medication before reaching maximum dose of first medication. Patient self-administered questionnaires were utilized to examine medication adherence, treatment satisfaction and quality of life (QoL).ResultsA total of 600 patients were included in the study. Overall, 23% of patients were treated based on GBP at 3 months, and the GBP rate increased to 61.4% at 6 months. At baseline and 6 months, 36.7 and 49.2% of patients, respectively, were medication adherent. The proportion of blood pressure-controlled patients reached 65.5% at 6 months. A higher blood pressure control rate was present in patients who were on GBP and also showed adherence than those on GBP, but not adherent, or non-GBP patients (76.8% vs. 70.9% vs. 54.2%, P < 0.001). The same outcomes were found for treatment satisfaction and QoL (P < 0.05).ConclusionsThis study demonstrated the importance of physicians’ compliance with GBP and patients’ adherence to hypertensive medications. GBP compliance and medication adherence should be taken into account when setting therapeutic strategies for better outcomes in uncontrolled hypertensive patients.
Highlights
Chronic diseases like hypertension need comprehensive lifetime management
Treatment patterns were used to examine whether physicians followed guideline-based practice (GBP), which was based on the Joint National Committee 8 guideline [6] and was defined if one of following criteria was met; (1) maximize the first medication before adding a second or (2) add a second medication before reaching the maximum dose of the first medication to control blood pressure (BP)
Patient characteristics between GBP and non-GBP, and between adherent and non-adherent groups at 6 months are described in the Table S1
Summary
Chronic diseases like hypertension need comprehensive lifetime management. This study assessed clinical and patient-reported outcomes and compared them by treatment patterns and adherence at 6 months among uncontrolled hypertensive patients in Korea. Hypertension is one of the major causes of death and the leading risk factor for cardiovascular disease and mortality worldwide [1]. Achieving and maintaining blood pressure (BP) goals in hypertension has been challenging. About one-third of hypertensive patients are unaware of this condition or, if aware, do not undergo treatment, and target BP values are seldom achieved. This failure to control BP is associated with persistent elevated cardiovascular risk [2]. Most guidelines are based on evidence from multiple randomized clinical trials (RCTs) and recommend that the clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. If goal BP is not reached, guidelines recommend increasing the dose of the initial drug or adding a second drug from one of the recommended classes [2,3,4,5,6]
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