Arterial Hypertension (AH): Medico-Demographic Situation, Treatment Adherence (TA), Quality of Life (QoL)

The dissertation is devoted to a comprehensive medico-social investigation of arterial hypertension as one of the leading causes of morbidity, disability, and mortality, particularly in the Republic of Tatarstan. The work analyzes the medico-demographic situation reflecting the prevalence of arterial hypertension and diseases of the circulatory system, as well as examines the key aspects of treatment adherence and quality of life among patients. Special attention is given to the correlation between the aforementioned medico-social characteristics and the levels of systolic and diastolic arterial blood pressure, which makes it possible to assess the degree of influence of hemodynamic parameters on the course of the disease and its consequences.

RELEVANCE OF THE PROBLEM. One of the most important prerequisites for the full and harmonious development of a human being is the absence of diseases. In this regard, the needs of society give rise to serious problems, the solution of which, in turn, becomes one of the primary tasks of medicine and healthcare at the present stage. Epochs succeeded one another, and the passage of centuries has determined changes in people's views on the concept of health and illness; however, as is well known, an inexhaustible value of any society has invariably been the achievement of active longevity, the striving to maximally defer the moment of the final chord of the symphony called "Life."

In earlier times, the main struggle of the advocates of the medical art was directed against infectious, parasitic diseases, as well as injuries, poisonings, and traumas, which primarily determined the picture of death; however, today so-called chronic ontobiotic (degenerative) diseases are acquiring ever greater relevance. The cause of such a state of affairs can be explained, on the one hand, by the significant successes of medical science and practice in the treatment and prevention of exogenous pathology, and on the other hand, by people "living through" to those ages at which diseases of the circulatory system and oncological diseases become dominant. It is necessary to draw attention to the fact that among "organic" disorders the leading role belongs to cardiovascular pathology, a significant increase in the level of mortality, primary disability, and morbidity of which has been observed over the past decades both in our country and abroad. Thus, statistical data indicate that in most economically developed countries of the world (with a high standard of living), diseases of the circulatory system are the cause of 39%–56% of deaths and, thus, firmly hold a leading position among all causes of human death: people die from them more often than from oncological diseases, accidents, and infectious diseases taken together — which, in turn, stimulates the necessity of a detailed examination of the prevailing nature of cardiovascular pathology also in the aspect of its prevalence, which consistently demonstrates a tendency toward intensification.

Having substantially spread over the past decade, cardiovascular pathology today largely determines the magnitude of such vitally important indicators of the health status of the population as mortality, disability, morbidity, average life expectancy, and others. Let us add that this nosological group makes a notable contribution to the number of days of disability and is a frequent cause of hospitalization of patients.

The growth in the significance of diseases of the circulatory system is due to the influence of numerous factors of both medical and socio-economic and demographic nature, one of which is the shift in the age structure of the population toward an increase in the number of elderly persons — through people "living through" to the 60-year age "threshold" and older. A relative improvement in socio-economic conditions, associated primarily with the processes of urbanization and industrial achievements of the past century, ensured "living through" to our days a rather large body of subjects born in the first half of the twentieth century, which led to the simultaneous "saturated" coexistence of several generations, largely contributing to an intensive growth in the overall level of mortality (a problem "hovering" over North America and Western Europe back in the 1960s). No small role here is played by the process of population aging in industrially developed countries and the increase in the number of cases of death, including from cardiovascular diseases, which inflict colossal damage on the health of people and society as a whole, the severity of which is compounded by morbidity and disability.

However, diseases of the heart and blood vessels are far from always the cause of death only in old and advanced age: a quite significant share is "formed" by them in the structure of mortality of persons of working age, thus reflecting a certain "rejuvenation" of cardiovasculopathy.

As we can see, the situation that has developed around diseases of the circulatory system, without doubt, affects broad segments of the population and, of course, cannot but attract the most close attention on the part of the medical community, in connection with which in recent decades the aspects of studying treatment adherence and quality of life among patients who are carriers of the discussed pathology, as well as among healthy subjects, are acquiring ever greater relevance.

OBJECTIVE OF THE RESEARCH:

To develop scientific-practical recommendations on the optimization of preventive measures and therapeutic approaches in arterial hypertension based on the study of the medico-demographic situation caused by the influence of the specified disease and its complications, as well as the state of treatment adherence and quality of life of patients depending on the levels of systolic and diastolic arterial blood pressure.

TASKS OF THE RESEARCH:

1. To give a medico-demographic characterization and a medico-social assessment of arterial hypertension in the structure of diseases of the circulatory system, formed in the Republic of Tatarstan at the beginning of the new century.

2. To present a medico-demographic characterization and a medico-social assessment of lesions of the blood vessels of the brain in the structure of diseases of the circulatory system, formed in the Republic of Tatarstan at the beginning of the new century.

3. To study the state and causes of "formation" of treatment adherence among patients with arterial hypertension based on an examination of the nature of the influence of a number of factors (compliance) — on the example of all respondents as a whole, among all examined patients with arterial hypertension without division into groups, and in each of the studied cohorts depending on the levels of systolic (SBP) and diastolic arterial blood pressure (DBP).

4. To study the state and causes of "formation" of quality of life among patients with arterial hypertension based on an examination of the nature of the influence of a number of factors (general well-being) — on the example of all respondents as a whole, among all examined patients with arterial hypertension without division into groups, and in each of the studied cohorts depending on the levels of systolic (SBP) and diastolic arterial blood pressure (DBP).

5. To identify and characterize the interrelationship between the aggregate indicator of quality of life (AIQoL) and the aggregate indicator of treatment adherence (AITA) with different magnitudes and at different levels of systolic (SBP) and diastolic arterial blood pressure (DBP) as these hemodynamic parameters increase — on the example of all respondents as a whole, among all examined patients with arterial hypertension without division into groups, and in each of the studied cohorts.

SCIENTIFIC NOVELTY OF THE WORK:

A medico-demographic characterization and a medico-social assessment of the prevalence of arterial hypertension, vascular lesions of the brain, and diseases of the circulatory system in general in the Republic of Tatarstan at the beginning of the new century is presented.

A method for the quantitative assessment of an individual's treatment adherence (compliance) as an independent medico-social characteristic, taking into account the degree of expression of the strength of influence of a number of medico-social factors, has been developed and tested for the first time.

A comprehensive clinical-social study of treatment adherence as an independent medico-social characteristic and of compliance factors among patients with arterial hypertension at different levels of systolic and diastolic arterial blood pressure, as well as among patients with consequences of acute cerebral circulation disorders against the background of high values of SBP and DBP, has been conducted for the first time.

A comprehensive clinical-social study of the quality of life of patients with arterial hypertension at different levels of systolic and diastolic arterial blood pressure, as well as among patients with consequences of acute cerebral circulation disorders against the background of high values of SBP and DBP, has been conducted.

The interrelationship between quality of life and treatment adherence as an independent medico-social characteristic has been studied in detail — on the example of all examined persons as a whole, all patients with arterial hypertension as a whole without division into groups, at different magnitudes of systolic and diastolic arterial blood pressure, as well as among patients with consequences of acute cerebral circulation disorders against the background of high values of SBP and DBP.

PRACTICAL SIGNIFICANCE OF THE WORK:

The results obtained in the research: promote a deeper comprehension of the consequences of the increase in the rates of growth of mortality, disability, and morbidity due to diseases of the circulatory system, in particular arterial hypertension and vascular lesions of the brain, and the associated aggravation of medico-social problems existing around treatment adherence of patients and the quality of their life; exert influence on the process of developing preventive strategies and educational programs for patients aimed at reducing the level of mortality, disability, and morbidity due to diseases of the circulatory system and, in particular, arterial hypertension and vascular lesions of the brain; contribute to the implementation, based on the calculation of the aggregate indicator of treatment adherence and the aggregate indicator of general well-being, of control over the quality and long-term effectiveness of antihypertensive therapy, as well as to the substantiation of the choice and prescription of an antihypertensive agent (combinations of drugs and/or their groups) corresponding to the above-mentioned requirements and allowing the solution of the stated treatment-preventive tasks in full; postulate the significance of factors of "formation" of treatment adherence and quality of life for the further development of scientific-practical recommendations on the optimization of approaches to the treatment of arterial hypertension based on the study of the medico-demographic situation caused by the influence of the specified disease and its complications.

MAIN PROVISIONS OF THE DISSERTATION PRESENTED FOR DEFENSE:

1. In the structure of all nosological groups of diseases of the circulatory system, formed in the Republic of Tatarstan at the beginning of the new century, — among persons of working age, the significance of arterial hypertension is in inverse dependence on the degree of health loss of the population.

2. Vascular lesions of the brain are the second most significant pathology (after ischemic heart disease) in the structure of diseases of the circulatory system, formed in the Republic of Tatarstan at the beginning of the new century.

3. Treatment adherence and quality of life among patients with arterial hypertension with high figures of systolic and diastolic arterial blood pressure, in comparison with all patients as a whole (without division into groups), subjects with insignificant and moderate elevations of SBP and DBP, as well as normotensive respondents, are at a substantially lower level. In turn, the decline of the discussed medico-social characteristics in the cohort of persons with consequences of acute cerebral circulation disorders against the background of high values of SBP and DBP manifests itself even more acutely.

4. As systolic and diastolic arterial blood pressure increase, treatment adherence among patients with arterial hypertension decreases, and quality of life worsens, and these trends are traced on the example of all examined patients as a whole, among respondents with normal values, as well as among persons with insignificant, moderate, and pronounced elevations of SBP and DBP.

5. In arterial hypertension, indicators of treatment adherence and quality of life are characterized by a combined unidirectional decline as the magnitudes of both systolic and diastolic arterial blood pressure increase.

WORK VALIDATION:

The main provisions and results of the dissertation research were reported at the V Scientific-Practical Conference of Young Scientists (Kazan, 2000), the VI Scientific-Practical Conference of Young Scientists (Kazan, 2001), at the republican scientific-practical conference "Actual Ethical-Legal Problems of Healthcare at the Present Stage" (Kazan, 2001), at the All-Russian Scientific-Practical Conference "Modern Opportunities for Effective Prevention, Diagnosis, and Treatment of Arterial Hypertension" (Moscow, 2001), at the Second National Congress of Cardiologists of the Russian Federation (Moscow, 2001), at the joint expanded meeting of the departments of biomedical ethics and medical law with a course in the history of medicine of KGMU and the faculty therapy department of KGMU on problems of cardiovascular pathology (Kazan, 10.04.2003), at the Central Problem Commission of the Central Research Laboratory of KGMU (Kazan, 21.01.2004), as well as at a scientific-practical seminar on the exchange of experience of specialists of the OOZ RT (Kazan, KGMA, 5.04.2004).

PUBLICATIONS:

Based on the materials of the dissertation, 8 printed works have been published, and a map of medico-social examination of a patient with cardiovascular pathology has been issued.