SOCIO-DEMOGRAPHIC AND CLINICAL PREDICTORS OF FAILURE TO ACHIEVE THE TARGET LEVEL OF BLOOD PRESSURE IN OUTPATIENTS WITH ISOLATED ARTERIAL HYPERTENSION AND IN COMBINATION WITH CARDIOVASCULAR COMORBIDITY

Abstract

The problem of achieving the target level of blood pressure (TBP) is extremely relevant today, as arterial hypertension (AH) is the leading modifiable risk factor for cardiovascular complications.The aim of the study is to investigate the relationships between achievement/failure of TBP and socio-demographic and clinical characteristics in outpatients with isolated AH and in combination with cardiovascular comorbidity and to determine probable predictors of failure to achieve TBP.Material and methods. The study was carried out on the basis of the municipal non-profit enterprise “Gulsk outpatient clinic for general practice of family medicine” of the Strievsky village council, the village of Striyevo, Zvyagelsky district, Zhytomyr region The study involved 140 patients with AH, divided into three groups: isolated AH (n=60), AH+coronary heart disease (CHD) (n=35), AH+CHD+chronic heart failure (HF) (n=45). Patients were considered to have achieved the TBP if their office BP was <140/90 mm Hg when measured twice with an interval of 1 month.Results. The absence of statistically significant changes according to achievement/failure of TBP between outpatients with isolated AH and AH with cardiovascular comorbidity (χ2=3.37; p=0.185) was revealed, while in the group with isolated AH 65.00%, in the group with AH + CHD – 45.71%, in the group of AH + CHD + HF – 57.78% of people did not reach the TBP. Analyzing the relationships between the achievement/failure of TBP and age, gender, social status and modifiable risk factors (smoking, alcohol abuse and salt abuse), statistically significant differences were found only in relation to salt abuse in outpatients with AH and cardiovascular comorbidity (in the group of AH + CHD 100.00%, and in the group AH + CHD + HF 96.15% of people who abuse salt did not reach the TBP). The results of the logistic regression analysis showed that the female gender is by 4.1 times more likely to be associated with failure to achieve TBP compared to the male gender in the group with isolated AH, by 3.5 times – in the group of AH+CHD, by 3.4 times – in the group of AH+CHD+HF; salt abuse increases the risk of not reaching the TBP in the group with isolated AH by 19.4 times; by 20.8 times – in the group of AH + CHD; by 21.1times – in the group of AH + CHD + HF. Analyzing the relationship between achievement/failure of TBP and clinical characteristics of outpatients with isolated AH, the duration of the disease in persons who did not reach TBP is 2.0 times longer than the catamnesis of persons who reached TBP (p<0.001); the degree and stage of arterial hypertension significantly affects achievement/failure of TBP (χ2=22.27; p<0.001 and χ2=7.66; p=0.022, respectively). The results of the logistic regression analysis show that an increase in BP (in particular, each subsequent degree of AH) is more often associated with failure to achieve TBP both in patients with isolated AH and in patients with AH and cardiovascular comorbidity: by 2.7 times in the group with isolated AH; by 2.8 times in the group of AH + CHD; by 3.0 times – in the group of AH+CHD+HF.Conclusions. Female gender, salt abuse, and the degree of AH are statistically significant factors associated with an increased risk of not reaching the target blood pressure level both in outpatients with isolated AH and in patients with AH combined with cardiovascular comorbidity.