Drug therapy of arterial hypertension: assessment of the physicians’ basic knowledge. Final results of the PHYSTARH project

Background. Arterial hypertension is a multifactorial disease accompanied by an increase in systolic and/or diastolic blood pressure above the established values. Uncontrolled blood pressure can cause various complications, which will lead to either disability or death of the patient. Aim. To assess the compliance of the level of doctors’ knowledge with current clinical guidelines in the treatment of arterial hypertension. Materials and methods. Within the framework of the PHYSTARH multicenter study, we presented the results of an anonymous prospective survey to assess the level of physicians’ knowledge and pharmacotherapeutic preferences in the treatment of arterial hypertension. Results. The study involved 425 physicians from 9 regions of Russia: Belgorod, Voronezh, Lipetsk, Chelyabinsk, Moscow, Krasnodar Territory, Primorye Territory, the Republic of Adygea and Tatarstan. In the course of the analysis, we revealed an insufficiently high level of the respondents’ knowledge in the treatment of arterial hypertension. Less than half of the respondents chose the indication of combination therapy as a therapeutic intervention in which the effectiveness of lowering blood pressure increases about 5 times more than when the dose of the original drug is doubled; correctly indicated the pharmacological group for the proposed drug (methyldopa), determined the indication for the use of aspirin in patients with hypertension, selected the optimal antihypertensive therapy for the proposed clinical situations, indicated absolutely contraindicated antihypertensive drugs in pregnancy and chronic obstructive pulmonary disease. Conclusion. The need for additional educational activities among physicians was established to improve the quality of knowledge on the basic aspects of hypertension, because a significant number of key questions on this topic cause difficulties for respondents.

arterial hypertension, arterial hypertension treatment, level of physicians’ knowledge, pharmacotherapeutic preferences, education programs for doctors, anonymous survey

1. Задионченко В.С., Шехян Г.Г., Ялымов А.А., Щикота А.М. Принципы выбора медикаментозной терапии артериальной гипертонии. Consilium Medicum. 2017;19(10):33-8 DOI:10.26442/2075-1753_19.10.33-38

2. Кобалава Ж.Д., Троицкая Е.А., Колесник Э.Л. Современные рекомендации по артериальной гипертонии: согласованные и несогласованные позиции. Рациональная фармакотерапия в кардиологии. 2019;15(1):105-14 DOI:10.20996/1819-6446-2019-15-1-105-114

3. Lawes CMM, Hoorn SV, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371(9623):1513-8. DOI:10.1016/S0140-6736(08)60655-8

4. Бойцов С.А., Баланова Ю.А., Шальнова С.А., и др. Артериальная гипертония среди лиц 25-64 лет: распространенность, осведомленность, лечение и контроль. По материалам исследования ЭССЕ. Кардиоваскулярная терапия и профилактика. 2014;13(4):4-14 DOI:10.15829/1728-8800-2014-4-4-14

5. Wald DS, Law M, Morris JK, et al. Combination therapy versus monotherapy in reduction blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009;122(3):290-300. DOI:10.1016/j.amjmed.2008.09.038

6. Mancia G, Fagard R, Narkiewicz K, et al.; Task Force Members. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281-357. DOI:10.1097/01.hjh.0000431740.32696.cc

7. Бонцевич Р.А., Вовк Я.Р., Гаврилова А.А., и др. Этиопатогенез, диагностика и подходы к лечению артериальной гипертонии: оценка базовых знаний врачей терапевтического профиля. Финальные результаты проекта PHYSTARH. Системные гипертензии. 2021;18(1):25-30 DOI:10.26442/2075082X.2021.1.200346

8. Гржибовский А.М., Иванов С.В., Горбатова М.А. Анализ номинальных и ранговых переменных данных с использованием программного обеспечения Statistica и SPSS. Наука и здравоохранение. 2016;6:5-39

9. Чазова И.Е., Жернакова Ю.В. от имени экспертов. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Системные гипертензии. 2019;16(1):6-31 DOI:10.26442/2075082X.2019.1.190179

10. Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373(9678):1849-60. DOI:10.1016/S0140-6736(09)60503-1

11. Jardine MJ, Ninomiya T, Perkovic V, et al. Aspirin is beneficial in hypertensive patients with chronic kidney disease: a post-hoc subgroup analysis of a randomized controlled trial. J Am Coll Cardiol. 2010;56(12):956-65. DOI:10.1016/j.jacc.2010.02.068

12. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105-87. DOI:10.1097/HJH.0b013e3281fc975a

13. Kharina VI, Berezhnova TA. Evaluation of the effectiveness of pharmacotherapy for brain and heart diseases by monitoring the effects of drugs. Research Results in Pharmacology. 2020;6(2):43-55. DOI:10.3897/rrpharmacology.6.52300

14. Прибылов С.А., Шабанов Е.А., Алиуллин Р.В., и др. Эндотелиопротекторные и гемодинамические эффекты сартанов при сочетании артериальной гипертензии, ишемической болезни сердца и хронической обструктивной болезни легких. Актуальные проблемы медицины. 2011;16(111). Режим доступа: https://cyberleninka.ru/article/n/endotelioprotektornye-i-gemodinamicheskie-effekty-sartanov-pri-sochetanii-arterialnoy-gipertenzii-ishemicheskoy-bolezni-serdtsa-i. Ссылка активна на 31.03.2021

15. Williams B, MacDonald TM, Morant S, et al.; British Hypertension Society’s PATHWAY Studies Group. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet. 2015;386(10008):2059-68. DOI:10.1016/s0140-6736(15)00257-3

16. Liu L, Xu B, Ju Y. Addition of spironolactone in patients with resistant hypertension: a meta-analysis of randomized controlled trials. Clin Exp Hypertens. 2017;39(3):257-63. DOI:10.1080/10641963.2016.1246564

17. Wang C, Xiong B, Huang J. Efficacy and Safety of Spironolactone in Patients with Resistant Hypertension: A Meta-analysis of Randomised Controlled Trials. Heart Lung Circ. 2016;25(10):1021-30. DOI:10.1016/j.hlc.2016.02.016

18. Кобалава Ж.Д., Конради А.О., Недогода С.В., и др. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(3):3786 DOI:10.15829/1560-4071-2020-3-3786

19. Bontsevich R, Chernykh A, Leonova A, et al. Physicians’ and undergraduates’ knowledge of drugs contraindicated for AH treatment. Eur J Clin Pharmacol. 2019;75(Suppl. 1):S28 (EACPT-1241). The Abstracts: 14th Congress of the European Association for Clinical Pharmacology and Therapeutics (EACPT). 29 June - 2 July 2019, Stockholm, Sweden. DOI:10.1007/s00228-019-02685-2

20. Bontsevich RA, Severinova OV, Chukhareva NA, et al. The successful clinical case of a severe arterial hypertension management during preconception and pregnancy. Indo Am J P Sci. 2018;5(10):10396-400. DOI:10.5281/zenodo.1467395

21. Leonova A, Bontsevich R, Chernykh A, et al. Assessment of physicians’ and senior medical students’ knowledge of antihypertensive drugs contraindications in COPD patients treatment. Eur J Clin Pharmacol. 2019;75(Suppl. 1):S28 (EACPT-1263). The Abstracts: 14th Congress of the European Association for Clinical Pharmacology and Therapeutics (EACPT). 29 June - 2 July 2019, Stockholm, Sweden. DOI:10.1007/s00228-019-02685-2