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Title: Drug intolerance in patients with hypertension, its prevalence and determining factors
Abstract:
Hypertension is one of the most common chronic diseases. The need for longterm treatment and the risk of developing cardiovascular complications constitute significant mental and somatic burdens for the patient. Arterial hypertension is rarely an isolated disease entity. The most common comorbidities include metabolic disorders (diabetes, hypercholesterolemia, hyperuricemia) or clinically overt complications, which are associated with the consumption of a large number of drugs and increase the risk of drug-induced adverse events. All these factors may have a negative effect on disease acceptance, and, as a consequence, the patient's compliance with the doctor's recommendations. Despite the availability of numerous guidelines for the management of arterial hypertension, studies of patients with hypertension and the general population indicate that more than half of patients with hypertension are untreated or undertreated, i.e. they do not achieve the target blood pressure values. One of the major reasons for insufficient blood pressure control is non-compliance with the physician's pharmacotherapy recommendations (non-adherence), and this problem is estimated to be prevalent in 30-50% of hypertensive patients. One of the factors behind insufficient patient adherence to medical recommendations is the occurrence of drug-induced adverse events. One increasing problem ; impeding the treatment of chronic diseases, including hypertension, is multi-drug intolerance, defined as a situation where a patient reports side effects from 3 or more classes of drugs. The aim of the study was to determine the incidence of drug-induced adverse events in the medical history of patients treated for hypertension. In addition, the authors analysed those factors associated with a higher incidence of adverse events in hypertensive women and men. The incidence of multi-drug intolerance and factors determining it were also assessed. The study included patients receiving long-term treatment for arterial hypertension in an outpatient clinic or who were scheduled for hospitalization in the Department of Interventional Cardiology and Interventional Electrocardiology and Hypertension of the University Hospital in Krakow with hypertension as their main diagnosis or identified as a comorbidity. The study was based on a structured original questionnaire, which the patient completed assisted by a member of the research team. The survey comprised 22 questions covering the patient's demographic and clinical factors. Diseases, risk factors, medications and side effects reported by the patients were also verified against the available medical documentation. The next part of the questionnaire concerned the presence or history of adverse drug-related events in a pa ; tient’s life. If the patient answered in the affirmative way, they were then asked to provide the name of the drug, the symptoms they experienced after taking them, as well as any severe symptoms, i.e., those requiring hospitalization. The level of disease acceptance was measured using the Acceptance of Illness Scale (AIS). The AIS scale comprises 8 statements describing the consequences of poor health. It defines three levels of disease acceptance: 8-18 points denotes a low level of disease acceptance, 19-29 points a medium level of disease acceptance, and 30-40 points a high level. The study population comprised a total of 1,000 people, i.e. 560 women and 440 men. The average age of the group as a whole was 62±14.96 years, ranging from 19 to 103 years of age. The average BMI in the study group was 27±4.84 kg/m2. The relationship between disease acceptance and the occurrence of drug-related adverse events was analysed in a subgroup of 532 patients (314 women and 218 men). Forty-five percent of the individuals had a high level of disease acceptance, while 46% of the patients had an average level of disease acceptance, and the remaining 9% of patients had poor acceptance. The study showed that the duration of hypertension in patients with a high level of disease acceptance was shorter than in patients with average disease acceptance. The incidence of cardiac disea ; ses in patients with a high level of disease acceptance was lower than in those with poor acceptance. In addition, the number of diseases in general was lower in people with a high level of disease acceptance than in people with average or poor disease acceptance. Mental disorders were significantly less common in those with a high level of disease acceptance than in those with average disease acceptance. Patients with a high level of disease acceptance also took significantly fewer noncardiac drugs than patients with average acceptance, and also took fewer drugs in general. Another analysis compared the number of drug-related adverse events in women and men and also assessed the factors associated with their higher incidence. Women took fewer drugs of any class than men, as well as fewer tablets of non-hypertensive cardiac medications. Within individual classes of drugs, women, compared to men, more often took angiotensin receptor antagonists, and less often antiplatelet drugs, statins, or cardiological drugs other than antihypertensive drugs. The occurrence of adverse events was reported more frequently by women. In the case of the latter, intolerance more often involved antibiotics and painkillers. Among the side effects, women significantly more often reported hypotension, cough, oedema, bradycardia, and skin lesions. Women with a history of adverse events e ; xperienced a significantly higher number of cardiological and non-cardiac diseases than women who did not report any drug-related events. These included ischemic heart disease, heart failure, respiratory system diseases and rheumatological diseases. Women reporting adverse drug reactions took antiplatelet drugs significantly more frequently, but took calcium antagonists less often than women without adverse drug reactions. The multivariate logistic regression model showed that the risk of drugrelated adverse reactions in women increases significantly with age and in cases where respiratory disease is present. Men reporting drug-related symptoms were older than men without a history of drug-related events. Men with side effects experienced a higher incidence of cardiac and non-cardiac diseases. Ischemic heart disease, heart failure, atrial fibrillation, hypercholesterolemia, and metabolic diseases were all significantly more common in men reporting adverse drug reactions. Men reporting side effects took significantly more classes of drugs and more non-hypertensive cardiovascular tablets than men without side effects, and more frequently took antiplatelet drugs, antithrombotic drugs, cardiac drugs other than antihypertensive drugs, but less often calcium antagonists. The multivariate logistic regression model for men revealed that the risk of druginduced side effe ; cts increased with the occurrence of hypercholesterolemia and metabolic diseases. As regards the study population as a whole, some kind of drug intolerance was noted in 48% of the subjects. In most cases such intolerance concerned only one drug (32% of the group). Multiple drug intolerance was noted in 80 subjects (8% of the entire research group), with the maximum number of drug intolerances being 8. Multiple drug intolerance was more common among women, as well as in those with a longer duration of hypertension and more frequent occurrence of non-cardiac diseases, such as respiratory, digestive, rheumatological and endocrine diseases. The number of antihypertensive tablets taken was lower among patients with multiple drug intolerance. Within individual classes of drugs, patients with multiple drug intolerance more often took rheumatic drugs, and less often ACE inhibitors, diuretics, antihypertensive drugs, statins. The most common side effects reported by patients with multiple drug intolerance were allergic reactions. The multivariate logistic regression model showed that the risk of multidrug intolerance increased significantly in patients with diseases of the digestive system as well as in those patients taking analgesics, beta-blockers, antiplatelet agents or antibiotics. In conclusion, it has been shown that a significant percentage of hypertensive patien ; ts have experienced adverse drug reactions in the past. Multiple drug intolerance is also common, which may make the task of selecting the appropriate antihypertensive therapy problematic. Elderly patients, women and patients with comorbidities are particularly at risk of drug intolerance, including multiple drug intolerance. When planning the patient’s current antihypertensive therapy it is important to supplement the patient’s medical history with questions regarding the occurrence of adverse drug events in the past as well as take into account the patient's hitherto experience with previously used drugs.
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Rada Dyscypliny Nauki medyczne
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Last modified:
Apr 26, 2024
In our library since:
Apr 26, 2024
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http://dl.cm-uj.krakow.pl:8080/publication/5093
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| Edition name | Date |
|---|---|
| UJCM90ba5417a8b14c3daa108f4bd188d07e | Apr 26, 2024 |
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