PRESCRIBED ANTIHYPERTENSIVE AGENTS IN PATIENTS WITH AND WITHOUT ITS “ESCAPE’’ PHENOMENON

Abstract

Objective: To identify the percentage of antihypertensive therapy (AHT) groups prescription in patients with and without delayed inefficiency of AHT (“escape’’phenomenon). Design and method: The study included 102 hypertensive patients (52 male, age 54.2 ± 9.8 years), whom were assigned 2–3 agents from various AHT group.In 2–3 weeks after therapy initiation (with the single correction if needed), all participants achieved the target blood pressure (BP). The latter was confirmed by office BP measurement (office BP) (<140/90mmHg, oscillometric method, OMRON, Japan), and by 24-hour ambulatory BP monitoring (ABPM) (mean 24-hour BP < 130/80mmHg, oscillometric method, BPLab, Russia). In 1 and 3 months after inclusion, the efficacy of AHT was reassessed by both measurement methods. The “escape’’ phenomenon was verified when BP became higher target by any method in any reassessment time. Adherence was calculated as the ratio of the number of correct medication intake days to the number of follow-up days multiplied by 100%. Results: 34 patients (33.3%) demonstrated the ‘escape’ phenomenon (Group 1), while BP level in 68 (66.7%) patients remained target (Group 2). There weren’t differences in the cardiovascular (CV) risk factors between groups (Table 1). Both groups received primarily fixed combinations of AHT, which resulted in 1.9 ± 0.7 tablets intake per day. There was comparably high adherence to treatment in groups (89.2 ± 3.8% in group 1, 90.2 ± 5.0% in group 2,p = 0.28). When comparing the percentage of different AHT groups, there was no difference revealed between groups, with the exception of more frequent ARA-II prescription in Group 1 (Table 2). Nevertheless, although in both groups the target BP levels were achieved, the BP in the Group 1 was higher already at the stage of inclusion (Table 2). Moreover, baseline systolic BP was found to be an ‘escape’ phenomenon predictor in univariate logistic regression model (for office BP: systolic BP> 128mmHg (OR 3.43 (95%CI 1.39–8.47,p < 0.00), for ABPM: 24-systolic BP> 124mmHg (OR 25.81 (95%CI 5.61–119.11,p < 0.00). Further studies on ‘escape’ phenomenon issue in patients with ARA-II intake are required. A higher frequency of ARA-II usage in the ‘escape’ group is likely due to overestimation of the continuing BP decline in 2–3 weeks after ARA-II prescription.