Adherence to taking medicines as a basis for prevention of cardiovascular diseases

The article discusses approaches to improving adherence to treatment with antihypertensive drugs and statins based on domestic and foreign experience, in particular, with the help of approaches proposed in the recommendations of the European Society of Cardiologists on Diagnostics and Treatment of Arterial Hypertension (ESC), updated in 2018. It is proposed to consider several levels to improve adherence: the level of the physician, the patient’s level, the level of prescription and the level of the healthcare system. The implementation of the principle of reducing the number of pills for the treatment of arterial hypertension can be achieved through the increased use of fixed combinations, such as lysinopril and prolonged action indapamide or lysinopril and amlodipine at the 1st stage of treatment selection. In the 2nd stage, a triple fixed combination of lysinopril, amlodipine and prolonged action indapamide can be used, thus maintaining the continuity of the therapy initiated. In patients with concomitant dyslipidemia, the authors suggest a fixed combination of lysinopril, amlodipine and rosuvastatin, which also improves adherence to statin therapy. 

1. Boitsov S.A., Balanova Yu.A., Shalnova S.A., Deev A.D., Artamonova G.V., Gatagonova T.M., Duplyakov D.V., Efanov A.Yu., Zhernakova Yu.V., Konrady A.O., Libis R.A, Minakov A.V., Nedogoda S.V., Oshchepkova E.V., Romanchuk S.A., Rotar’ O.P., Trubacheva I.A., Chazova I.E., Shlyakhto E.V. on behalf of the participants of the ECVD-RF study. Cardiovascular therapy and prevention [Kardiovaskulyarnaya terapiya i profilaktika.]. 2014;13(4):4-14. (In Russ).

2. Tomaszewski M., White C., Patel P., Masca N., Damani R., Hepworth J., Samani N.J., Gupta P., Madira W., Stanley A., Williams B. High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/ MS) urine analysis. Heart. 2014;100(11):855–861. doi: 10.1136/heartjnl-2013-305063.

3. Williams B., Mancia G., Spiering W., Agabiti Rosei E., Azizi M., Burnier M., Clement D.L., Coca A., de Simone G., Dominiczak A., Kahan T., Mahfoud F., Redon J., Ruilope L., Zanchetti A., Kerins M., Kjeldsen S.E., Kreutz R., Laurent S., Lip G.Y.H., McManus R., Narkiewicz K., Ruschitzka F., Schmieder R.E., Shlyakhto E., Tsioufis C., Aboyans V., Desormais I.; Authors/Task Force Members. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of ESC and ESH. Eur Heart J. 2018;36(10):1953-2041. doi: 10.1097/HJH.0000000000001940.

4. Corrao G., Parodi A., Nicotra F., Zambon A., Merlino L., Cesana G., Mancia G. Better compliance to antihypertensive medications reduces cardiovascular risk. J Hypertens. 2011;29:610– 618. doi: 10.1097/HJH.0b013e328342ca97.

5. Burnier M., Wuerzner G., Struijker-Boudier H., Urquhart J. Measuring, analyzing, and managing drug adherence in resistant hypertension. Hypertension. 2013;62(2):218–225. doi: 10.1161/HYPERTENSIONAHA.113.00687.

6. Naderi S.H., Bestwick J.P., Wald D.S. Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med. 2012;125:882–887. doi: 10.1016/j. amjmed.2011.12.013.

7. Kontsevaya A.V., Romanenko T.S., Vygodin V.A., Fitilev S.B. Pharmacoepidemiology and effectiveness of antihypertensive therapy in the real practice of a specialized cardiological institution. Rational pharmacotherapy in cardiology [Racional’naya farmakoterapiya v kardiologii.]. 2015;11(1):8-17. (In Russ).

8. Fung V., Graetz I., Reed M., Jaffe M.G. Patientreported adherence to statin therapy, barriers to adherence, and perceptions of cardiovascular risk. PLoS ONE. 2018;13(2):e0191817. https://doi.org/10.1371/journal.pone.0191817.

9. Diagnosis and correction of lipid metabolism disorders to prevent and treat atherosclerosis. Russian Recommendations VI revision. Atherosclerosis and dyslipidemia [Ateroskleroz i dislipidemii]. 2017;3:5-22. (In Russ).

10. Yu.A. TRIUMVIRAT: reduction of the risk of cardiovascular complications in patients with arterial hypertension using a three-component combination of antihypertensive and lipid-reducing drugs. Cardiology [Kardiologiya]. 2015;55(9):10–15. (In Russ).