Controlled and uncontrolled arterial hypertension: comparison of clinical and demographic characteristics in patients (according to the National Registry of Hypertension, 2019-2022)

Abstract

   Aim: to analyze the features of antihypertensive therapy in a sample of patients with arterial hypertension observed in primary healthcare (2019-2022), to identify the features of therapy in patients with uncontrolled and controlled hypertension.   Materials and methods. An analysis was made of antihypertensive therapy in 4543 patients, the frequency of prescription of various combinations ofantihypertensive drugs. For statistical data processing, the SPSS statistical software package was used. Drug combinations prescribed in less than 2% of cases were excluded from the graphical presentation.   Results. The majority of patients with hypertension were prescribed combined AHT (2, 3 and 4-component therapy represented in 28.3 %, 33 %, 24.8 %, respectively). More than 90 % of patients receive drugs that block the RAAS system, more than 85 % – BB. Every third patient received a CCB, diuretic therapy most often prescribed mineralocorticoid receptor antagonists (39.8 %), loop diuretics (20 %). Thiazide-like diuretics are prescribed 1.8 times more often than thiazide ones (18.6 % and 10.1 %). In the structure of monotherapy in patients with hypertension, the leading prescriptions are BBs, ACEIs and ARBs (43.3 %; 31.4 %; 15.1 %) with a high incidence of coronary heart disease and heart failure. Combinations of BB, ACEI and ARB form the most frequently prescribed double combinations (BB+ACEI – 48.3 %; ARB and BB – 22.8 %). Almost all of the most commonly prescribed 4-antihypertensive combinations contained MRA. Among patients with controlled and uncontrolled hypertension, the frequency of prescription of different classes of antihypertensive drugs as monotherapy did not differ. Features of combination therapy in patients with uncontrolled hypertension included more frequent prescription of BB+ARB (25.6 % vs. 20.8 %), BB+ARB+TlD (15.7 % vs. 10.3 %), BB+ARB+CCB (11.1% vs. 6.3 %), ARB+CCBd+TlD (2.9 % vs. 1 %), BB+BRA+CCBd+TlD (15.3 % vs. 8.1 %), BB+ ACEI+CCBd+TlD (7.1 % vs. 2 %), BB+ACEI+CCBd+TlD+AB (5.3 % vs. 0 %), BB+ARB+CCBd+TlD+AB (5.3 % vs. 0 %). Patients with controlled hypertension were more often prescribed BB+ACEI (53.5 % vs. 41.3 %), BB+ACEI+MRA (22.8 % vs. 13.5 %), BB+ACEI+LD (3.6 % vs. 1.4 %), BB+ACEI+LD+MRA (27.1 % vs. 14.1 %), BB+ACEI+CCBd+MRA (19.6 % vs. 5.8 %), BB+ACEI+TD+MRA+LD (2.5 times, (23.8 % vs. 9.6 %)), BB+ACEI+CCBd+MRA+TD (5 times, (14.9 % vs. 2.9 %).   Сonclusions. Further escalation of the use of combination therapy is necessary given the high rate of failure to achieve target values.