Zbitnieva V. Improving the differential diagnosis of resistant and pseudoresistant hypertension and improving adherence to antihypertensive therapy in the family doctor’s practice.

The thesis is dedicated to solution of scientific problems in general practice and family medicine, namely, the perfectioning of differential diagnosis of essential resistant and pseudoresistant hypertension and patient-oriented methods for improving the adherence to antihypertensive therapy in the practice of a family doctor. Based on a comparative study of different methods of differential diagnosis of essential resistant and pseudoresistant hypertension, scientifically proved the effectiveness of the new method in a significantly reduction in the timing of the differential diagnosis up to (3.9±2.6) days, compared with the traditional method – (16.4±6.8) days (p<0.05), which allows to achieve a significant reduction in systolic blood pressure (> 10% of the baseline level) on average (4.5±1.5) days than with the traditional method ‒ (20.2±3.6 days) (p<0.05). Also, for the first time, scientifically grounded additional patient-oriented methods of improving the adherenсe to treatment of patients with arterial hypertension and the effectiveness of these methods in the long-term maintenance of a high level of adherence to antihypertensive treatment and target blood pressure level than the use of only conventional methods of compliance improving. Based on the long-term consequences of treatment, support the target blood pressure levels during the year in significantly number of patients - at (66,7±8,6) % in the intervention group versus (20,0±7,3) % in the comparison group (p<0.001). The use of additional patient-oriented methods of correction of poor adherence to antihypertensive treatment can adjust the complex of patient-related and drug-related causes in most patients with pseudoresistant hypertension - (89.3±5.8) %, unlike patients whom performed only the usual correction - only in (33,3±9,1) % of patients (2=19,7 df =1 p<0.01). The results of the study have practical importance, which is reflected in the practical recommendations proposed for institutions of practical medicine of the primary level. Based on the performed research, the new method of differential diagnosis of essential resistance and pseudoresistant hypertension was developed, tested and implemented in the practice of family doctors, questionnaires for determining the reasons for the violation of adherence to treatment and provided practical recommendations for the use of individualized additional patient-oriented methods for improving adherence to treatment in patients with pseudoresistant arterial hypertension.