According to the WHO, 30-45% of the total population has high blood pressure (BP), of which Ukraine accounts for about 12 million. Today, hypertension (AH) continues to be the most common risk factor for cardiovascular events, despite the achievement in diagnostics and modern possibilities of drug correction (WHO / ISH Hypertension guidelines, 2020).
Management of patients with hypertension for more than a decade remains an important issue in the field of health care both in Ukraine and around the world (He D, Zhang W, Walton RG, 2018). Current trends in health care, in particular blood pressure control and continuous development of technological devices should develop in parallel (Bodenheimer T, Pham HH, 2019).
Given the trend towards optimizing medical costs, developing patient-centered care and increasing commitment to self-monitoring, telemonitoring (TM) as a diagnostic method may play a key role in the future (Miyata Y, Mukohara K, Nihon Naika Gakkai Zasshi., 2019).
The aim of the study: to increase the effectiveness of blood pressure control and adherence to treatment in patients with hypertension and overweight by studying the clinical features, characteristics of psychological status and indicators of daily monitoring and telemonitoring of blood pressure.
Objectives of the study:
1. To determine the frequency of concomitant pathology and clinical features of hypertension in overweight patients.
2. Analyze the psychological status of patients with hypertension and overweight.
3. To investigate the quality of life and level of anxiety in patients with hypertension and overweight after the use of telemonitoring of blood pressure.
4. Conduct a comparative analysis of 24-hour ambulatory blood pressure monitoring in patients with hypertension and overweight.
5. Compare the level of achievement of blood pressure targets after the use of telemonitoring of blood pressure in patients with hypertension and overweight.
6. Assess the dynamics of adherence to treatment and determine the factors of low compliance in patients with hypertension and overweight.
Scientific novelty of the obtained results
An in-depth comparative analysis of the clinical picture of hypertension in patients with normal and overweight and found that these patients have a significantly higher number of comorbidities, more often take triple combination antihypertensive therapy and have a higher percentage of bad habits (such as alcohol consumption and sedentary lifestyle).
It was studied that according to the assessment of the psychological profile, patients with hypertension and overweight had statistically higher rates of anxiety (both personal and reactive) and hypochondria, while the level of optimism was reduced. In addition, the level of QOL is statistically lower than in patients with normal body weight due to scales of physical function, general health, vital activity and role functioning.
The daily BP profile in overweight patients was analyzed and found to have significantly higher DBP time index and night hypertension. The difference in achieving the blood pressure targets using home measurement and telemonitoring was revealed. Thus, in patients with both normal and overweight after the use of the telemedicine, the numbers of both CAT and DBP significantly decreased, and the daily blood pressure profile improved.
For the first time, it was found that the use of telemonitoring of blood pressure increases adherence to treatment, improves medical and diagnostic compliance, which in turn significantly reduces blood pressure in both patients with normal and overweight. The correlation between insufficient adherence to treatment and related factors was analyzed.
A comparative analysis of the results of office and home monitoring of blood pressure and found a significant difference in indicators.
Achieving BP targets was found to be associated with improved QOL, a significant reduction in anxiety, and increased compliance in patients with both normal and overweight.
The practical significance of the obtained results
The study makes it possible to increase the effectiveness of blood pressure control in patients with hypertension and normal and overweight, to expand the current data on the factors of reduced compliance in them.
Assessment of socio-demographic factors revealed that overweight patients have a higher stage of hypertension, a burdensome family history and a higher degree of cardiovascular risk compared with patients with normal body weight, which is one of the key values for choosing the optimal treatment tactics and reduction of cardiovascular complications in the daily practice of the doctor.
It was found that a larger number of daily pills significantly reduces adherence to treatment, which in turn requires the selection of optimal treatment regimens to achieve optimal results.
