1. Low Adherence of Hypertension Patients to Treatment – What Is To Be Done? Clinical Problem for Public Health Alexander V. Sergeev, MD, PhD, MPH Irina B. Bazina, MD, PhD Smolensk State Medical Academy Smolensk, Russia

2. Hypertension: is it really dangerous? People don’t die of hypertension itself, but … they die of its complications Target organ damage (heart, brain, kidneys) CHD and stroke are causes of disability and death

3. Hypertension & Public Health High prevalence  burden from public health perspective BP over 140/90 in over 1/3 of adult population Particular concern: high prevalence among workforce

4. Hypertension: actual problem for Russia Rise in mortality from the major complications of hypertension – CHD and stroke – during the last 20 years High prevalence among workforce Early disability; decreased life expectancy

5. The problem of hypertension patients’ low compliance to therapy Low percentage of those who take medications regularly and have their BP controlled effectively Decrease in compliance among males as compared to 1980s Patients’ attitude to their health Low priority of health on one’s values scale Being inadequately informed of disease The result is sad: Irregular treatment cannot stabilize BP at safe level

6. Objective To analyze the factors associated with low adherence of hypertension patients to treatment To work out recommendations on development of population level approaches to solving the problem of low adherence from public health perspective

7. Methods Study design: cross-sectional study Study population: essential hypertension (stages I-III) patients of young age (22-45 yrs old) Catchment area: employees of organizations located in Smolensk Oblast N=224 Questionnaire: questions pertaining to knowledge of hypertension and attitude to various aspects of the disease including the necessity of treatment

8. Statistical Analysis Binary outcome variable Probability of getting negative answer to the question: “Do you think that hypertension patients should be on permanent treatment?” Multiple logistic regression – simultaneous control for a number of factors influencing binary outcome variable SAS software, PROC GENMOD

9. “Do you think that hypertension patients should be on permanent treatment?” 101 (45.09%) patients gave negative answer

10. Factors associated with hypertension patients’ noncompliance/compliance to treatment Model parameters OR95% CI Male (vs. female) gender1.623(0.722, 3.651) Age (vs. 22-30 yrs) 31-40 yrs1.213(0.552, 2.665) 40-45 yrs1.085(0.487, 2.417) Duration of disease (vs. <1 yr) 1-3 yrs0.298(0.128, 0.696) >3 yrs0.190(0.080, 0.453) Presence (vs. absence) of the clinical sequelae of hypertension 0.292(0.162, 0.526)

11. Low adherence risk group Short length of disease No clinical sequelae of hypertension (asymptomatic patients)

12. What can be expected of risk group? Behavioral pattern and peculiarities of self-perception of the disease Anosognosic attitude to the disease “I feel OK even when my blood pressure is 180/110. And 170/100 is my usual BP. So, there is no need for treatment, and I am not going to see the doctor!”

13. Health Belief Model Patient: subjective perception of health status and disease severity Physician: objective assessment Who is right?

14. What can be done to improve the situation? Low effectiveness of individual level influences Need for population level influences Information campaigns analogous to social advertising

15. The cost of the medicine and adherence: myths and realities Cost is not a major determinant Free medications cannot guarantee adequate adherence

16. Physicians and public health professionals against low compliance – who should be the leader? Interdisciplinary task Public health professionals’ competence in population level influences

17. Thank you!