Pharmacological treatment of hypertension: Therapeutic response and factors involved in the lack of effectiveness

FAVRETO M; GAUNA COLÁS CF; DI SALVO HE; GUILLERMO A KELLER; MARTINEZ ROCÍO; GOTELLI M; DI GIROLAMO GUILLERMO; SANCHEZ GELÓS D; FERREIRÓS GAGO ML; DIEZ RA

Mar del Plata

Congreso; REUNIÓN ANUAL DE SOCIEDADES DE BIOCIENCIA 2019; 2019

Sociedad Argentina de Investigación Clínica (SAIC)

Introduction: Hypertension is a highly prevalent disease and causes cardiovascular morbidity and mortality. Despite the great advances in pathophysiological research and available drugs, its control has not been as expected.Objective: To investigate the characteristics that determine the therapeutic response in hypertensive patients who undergo ambulatory blood pressure monitoring (ABPM).Methods: all patients who underwent ABPM were consulted about their participation. Upon acceptance, they were submitted to a questionnaire on cardiovascular risk factors, diet, exercise, and pharmacotherapeutic risk situations. ABPM results were also recorded and correlated with epidemiological data.Results: 119 patients (59 males, 49.58%) were included. The mean ± SD (min-Max) characteristics were: age 57 ± 14.5 (19-86) years, weight 81 ± 19.41 (43-147) kilograms, height 167 ± 11.47 (137-195) cm, BMI 29 ± 6.45 (16-53) Kg/m2 and abdominal circumference 104 ± 60 (60-210). Most of the patients had full university studies (52.94%), followed by complete secondary studies (36.97%). The presurometry was requested by recent diagnosis of Hypertension (26.89%) or by prior known hypertension follow-up (73.11%). The majority never smoked (63.87%), while the rest currently smokes (15.97%) or quit in recent years (20.17%). They reported sleeping on average 07:12 Hs ± 01:26 (01:30 to 10:45 Hs). Only 11.76% said they were complying with a hyposodic diet, while 39.5% mentioned it as nutritionally adequate, and 48.74% said they did not control their diet. Alarmingly, a large percentage do not perform physical activity (47.90%), or perform it sparingly (18.49%), while only 33.61% perform it properly. A striking number recognized risky behaviors such as: forgetting to take the medication (18%), being irregular in its intake (24%), not taking it when it feels good (13%) or stop taking it if they think feeling bad (22% ). Symptoms commonly associated with hypertension records were of very low prevalence: headache (19.33%), eye pain (5.88%), dizziness (9.24%), weakness (5.88%), nausea (4, 20%), abdominal pain (7.56%), dyspnea (8.40%), neck pain (12.61%) and fatigue (8.40%). The pharmacological treatment was correctly indicated in the majority. The pharmacological treatment was correctly indicated in the majority and it was consistent with the recommendations of therapeutic guidelines. Irrational prescription patterns were not detected. Regarding ABPM, 83% of patients had uncontrolled systolic and diastolic arterial hypertension. The majority (67%) with an altered circadian pattern. The factors that significantly correlated with the lack of control were: lack of adequate nutritional regimen, obesity, risky pharmacotherapeutic behaviors (no medication), insufficient hours dedicated to sleep.Conclusion: Despite the great pathophysiological and pharmacological knowledge, the response to antihypertensive treatment is still conditioned by sociocultural factors that must be approached in an interdisciplinary way to achieve therapeutic goals.