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Revista  
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Ciencias  
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Naturales  
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Año 12 N° 33  
Mayo - Agosto 2021  
Tercera Época  
Maracaibo-Venezuela  
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021  
A. M. Kardangusheva et al.// Study of adherence to therapy in patients with arterial… 264-273  
DOI: http://dx.doi.org/10.46925//rdluz.33.18  
Study of adherence to therapy in patients with arterial  
hypertension and comorbidity  
Aksana Muhamedovna Kardangusheva *  
Inna Fuadovna Pshigotizheva **  
Leila Dadashevna Kardanova ***  
Sofiat Khasenovna Sizhazheva ****  
Svetlana Zaurovna Shigalugova *****  
Inna Mukhamedovna Dudarova ******  
ABSTRACT  
The aim of the research is to study the parameters of tolerance and adherence to antihypertensive  
therapy in patients with arterial hypertension and comorbidity in real clinical practice. Material and  
methods. The study included 138 adult patients (29% of men and 71% of women) with arterial  
hypertension and comorbidity receiving therapy in the cardiology department. The average age of the  
patients was 64.3 ± 12 years. Results. The mean Charlson index in our study was 3.97 ± 2.0 points (3.75  
±
2
2.3 points for men and 4 ± 1.9 points for women). Treatment adherence was low in 40% of men and  
4.5% of women. The lowest rates of adherence were found to medical follow-up (85% in men and 83.6%  
in women) and lifestyle modifications (80% in men and 77.5% in women), the highest rates of adherence  
were to drug therapy (20 % for men and 18.4% for women). Significant correlations were found for all  
adherence categories with age and the number of drugs taken.  
Conclusion. Adherence to treatment in almost a third of the patients we surveyed was low. The lowest  
rates of adherence were found to medical support and lifestyle modifications, the highest were found to  
drug therapy. The factors influencing adherence, efficacy and tolerability of treatment includes age and  
the number of drugs taken.  
KEY WORDS: adherence to therapy; arterial hypertension; cardiovascular diseases; comorbidity.  
*
Associate Professor, Head of the Department of Public Health, Health Care and Preventive Medicine Kabardino-  
Balkarian State University named after H.M. Berbekov Nalchik, Russia. ORCID: 0000-0002-2960-7928 E-mail:  
kardangush@mail.ru  
*
*6th year student of the specialty "General Medicine" of the Faculty of Medicine Kabardino-Balkarian State University  
named after H.M. Berbekov Nalchik, Russia. ORCID: https://orcid.org/0000-0002-7048-4173 E-mail:  
pshigotizheva@gmail.com  
*
** Candidate of medical Sciences, Associate Professor of the Department of General Medical Practice and Medical  
Rehabilitation Kabardino-Balkarian State University named after H.M. Berbekov Nalchik, Russia. ORCID:  
https://orcid.org/0000-0003-1570-2497 E-mail: leilakardanova@yandex.ru  
*
*** Assistant of the Department of Public Health, Health Care and Preventive Medicine Kabardino-Balkarian State  
University named after H.M. Berbekov Nalchik, Russia. ORCID: https://orcid.org/0000-0002-4412-6700 E-mail:  
sofiat.sizhazheva@mail.ru  
*
**** Postgraduate student of the Department of Public Health, Health Care and Preventive Medicine Kabardino-  
Balkarian State University named after H.M. Berbekov Nalchik, Russia. ORCID: https://orcid.org/0000-0003-3128-0861  
E-mail: shigalugova1991@mail.ru  
****** Postgraduate student of the Department of Public Health, Health Care and Preventive Medicine Kabardino-  
Balkarian State University named after H.M. Berbekov Nalchik, Russia. ORCID: https://orcid.org/0000-0002-2684-7301  
Recibido: 01/02/2021  
Aceptado: 29/03/2021  
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A. M. Kardangusheva et al.// Study of adherence to therapy in patients with arterial… 264-273  
DOI: http://dx.doi.org/10.46925//rdluz.33.18  
Estudio de adherencia al tratamiento en pacientes con hipertensión  
arterial y comorbilidad  
RESUMEN  
El objetivo de la investigación es estudiar los parámetros de tolerancia y adherencia a la  
terapia antihipertensiva en pacientes con hipertensión arterial y comorbilidad en la práctica  
clínica real. Material y métodos. El estudio incluyó a 138 pacientes adultos (29% de hombres  
y 71% de mujeres) con hipertensión arterial y comorbilidad que recibían terapia en el  
departamento de cardiología. La edad media de los pacientes fue de 64,3 ± 12 años.  
Resultados. El índice de Charlson medio en nuestro estudio fue de 3,97 ± 2,0 puntos (3,75 ±  
2,3 puntos para los hombres y 4 ± 1,9 puntos para las mujeres). La adherencia al tratamiento  
fue baja en el 40% de los hombres y en el 24,5% de las mujeres. Las tasas más bajas de  
adherencia se encontraron al seguimiento médico (85% en hombres y 83,6% en mujeres) y  
modificaciones del estilo de vida (80% en hombres y 77,5% en mujeres), las tasas más altas de  
adherencia fueron a la farmacoterapia (20% para hombres y 18,4% para mujeres). Se  
encontraron correlaciones significativas para todas las categorías de adherencia con la edad  
y el número de fármacos consumidos. Conclusión. La adherencia al tratamiento en casi un  
tercio de los pacientes que encuestamos fue baja. Se encontraron las tasas más bajas de  
adherencia al apoyo médico y las modificaciones del estilo de vida, y las más altas a la terapia  
con medicamentos. Los factores que influyen en la adherencia, la eficacia y la tolerabilidad  
del tratamiento incluyen la edad y el número de fármacos que se toman.  
PALABRAS CLAVE: adherencia a la terapia; hipertensión arterial; enfermedades  
cardiovasculares; comorbilidad.  
Introduction  
Arterial hypertension is a leading risk factor for the development of cardiovascular  
(
myocardial infarction, stroke, coronary heart disease, chronic heart failure), cerebrovascular  
ischemic or hemorrhagic stroke, transient ischemic attack) and renal (chronic kidney  
(
disease) diseases as well as the main factor of premature death and the cause of about 10  
million deaths and more than 200 million cases of disability in the world (Chazova and  
Zhernakova, 2019; Franklin et al., 2009; Williams et al., 2018). A distinctive feature of arterial  
hypertension is the high frequency of comorbidity, which leads to mutual influence on the  
course of the disease, determines the nature and severity of complications, complicates  
diagnosis and therapy. Despite the large number of antihypertensive drugs used, blood  
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A. M. Kardangusheva et al.// Study of adherence to therapy in patients with arterial… 264-273  
DOI: http://dx.doi.org/10.46925//rdluz.33.18  
pressure control remains an urgent task today. Researchers believe that one of the reasons  
for poor blood pressure control in hypertensive patients is their low adherence to therapy  
(
Khokhlov et al., 2003; Chowdhury et al., 2013). Adherence to treatment in patients with  
CVD is one of the most important factors that ensure the quality of therapy and directly affect  
the prognosis (Ho et al., 2009; Martsevich et al., 2017). Adherence to treatment is commonly  
understood to mean the degree of compliance of the patient's behavior with respect to the  
recommendations received from the doctor in relation to drug therapy, adherence to diet,  
lifestyle changes and other components of disease control (National recommendations of the  
Russian Scientific Medical Society of Physicians for the quantitative assessment of adherence  
to treatment, 2017).  
Low adherence to therapy for any disease reduces the effectiveness and increases the  
cost of treatment, increases the risk of complications, worsens the prognosis of the disease  
and life (Lukina et al., 2017). The most vulnerable in terms of poor adherence to treatment  
are patients with chronic diseases that are asymptomatic or asymptomatic and require long-  
term therapy. So, according to experts, long-term adherence to therapy regardless of the  
disease is no more than 50%, and 43-78% in chronic diseases (Osterberg and Blaschke, 2005).  
According to the WHO classification, more than 250 factors are identified, combined  
into 5 groups, affecting patient compliance with medical recommendations. These are factors  
associated with patients, factors associated with doctors and the organization of the health  
care system, factors of drug therapy, factors of disease and a group of socio-economic factors  
(
World Health Organization, 2003). The most well-studied group of factors associated with  
patients. However, in the results of numerous studies, there is no uniformity of data on this  
issue (Khokhlov et al., 2003; Martsevich et al., Lukina et al., Osterberg and Blaschke, 2005).  
Thus, a deeper and more versatile study of the adherence of hypertensive patients to therapy  
is of scientific and practical interest.  
The purpose of the research is to study the parameters of tolerance and adherence to  
antihypertensive therapy in patients with arterial hypertension and comorbidity in real  
clinical practice.  
1
. Material and methods  
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DOI: http://dx.doi.org/10.46925//rdluz.33.18  
The study was carried out in the cardiology department of the State Budgetary  
Healthcare Institution "City Clinical Hospital No. 1". The study included 138 patients (29%  
men and 71% women). The age of the surveyed was 64.3 ± 12.0 years (61.5 ± 14.0 years for men  
and 65.4 ± 11.0 years for women). Inclusion criteria: age over 18 years old, diagnoses of arterial  
hypertension established in the framework of standard clinical practice (with blood pressure  
at the visit more than 140/90 or 140/85 mm Hg in patients with diabetes mellitus),  
undergoing therapy in the cardiology department, the presence of comorbidity (obesity,  
daibetes mellitus, chronic obstructive pulmonary disease, coronary heart disease, chronic  
heart failure, cerebrovascular disease, chronic kidney disease etc.) and lack of exclusion  
criteria - patient's disagreement to participate in the study.  
The survey included, in addition to general clinical studies in accordance with current  
clinical guidelines and standards for managing patients with arterial hypertension (Chazova  
and Zhernakova, 2019), a survey to quantify adherence to treatment according to a  
questionnaire developed by experts from the Russian Scientific Medical Society of  
Physicians (National recommendations of the Russian Scientific Medical Society of  
Physicians for the quantitative assessment of adherence to treatment, 2017).  
The questionnaire is a questionnaire completed by the respondent (either  
independently or with the participation of an interviewer), which includes 25 multiple  
choice questions, a data processing algorithm (with an electronic application for automated  
data processing) and a list of clinical recommendations for a doctor and patient  
corresponding to the identified level of adherence in the main clinically significant categories  
(
drug therapy; medical follow-up; lifestyle modifications). For all adherence indicators, the  
level of values in the range of up to 50% is interpreted as “low”, from 51% to 75% as “average”,  
more than 75% as “high” (National recommendations of the Russian Scientific Medical  
Society of Physicians for the quantitative assessment of adherence to treatment, 2017). To  
assess comorbidity, the Charlson index was used, which is a scoring system for assessing age  
and the presence of certain concomitant diseases. When calculating it, the points  
corresponding to concomitant diseases are summed up (Oganov et al., 2017).  
Statistical analysis of the research results was carried out using Microsoft Excel 2019.  
The analysis results are presented as the mean and its standard deviation for continuous  
variables and as a percentage (in percent) for categorical variables. The critical level of  
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DOI: http://dx.doi.org/10.46925//rdluz.33.18  
significance when testing statistical hypotheses was taken as p <0.05. Evaluation of the linear  
relationship (association) between qualitative characteristics was carried out using  
correlation analysis.  
2
. Research results  
The structure of comorbidity of the patients with arterial hypertension examined by  
us is presented in Table 1.  
Table 1. The structure of comorbidity in patients with arterial hypertension  
Total  
Women  
Men  
The number of  
comorbidities  
n
%
7
n
%
6
n
4
%
10  
35  
10  
15  
10  
10  
10  
1
2
3
4
5
6
7
10  
38  
20  
32  
16  
10  
14  
6
24  
16  
26  
12  
6
28  
14  
23  
11  
24  
16  
26  
12  
6
14  
4
6
4
7
4
10  
10  
10  
4
Of practical interest is the high prevalence of overweight (45% of men, 20% of women)  
and obesity (55% of men and 65% of women) revealed in the examined patients with arterial  
hypertension. Moreover, abdominal obesity was detected in 87% of patients (80% of men and  
89% of women). Along with obesity, chronic obstructive pulmonary disease (17.4%) and  
diabetes mellitus (5.8%) were most often recorded in patients with arterial hypertension. Of  
the patients examined by us, 33.3% had a CVD-burdened heredity, 7.3% continued to smoke  
even after the development of the disease.  
Proceeding from the fact that comorbid diseases in patients with arterial hypertension  
may indirectly affect adherence to therapy by increasing the number of drugs recommended  
for patients, we investigated the structure of comorbid pathology. The distribution of  
hypertensive patients according to the comorbidity index is presented in Table 2.  
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DOI: http://dx.doi.org/10.46925//rdluz.33.18  
Table 2. Distribution of patients with arterial hypertension by comorbidity index  
Total  
Women  
Men  
Charlson Index  
(
points)  
n
16  
12  
28  
28  
22  
14  
12  
2
%
11,6  
8,7  
20,3  
20,3  
15,9  
10,1  
8,7  
n
%
10  
10  
18  
22  
18  
12  
8
n
6
2
10  
6
4
2
4
0
2
%
15  
5
25  
15  
10  
15  
10  
0
1
10  
10  
18  
22  
18  
12  
8
2
3
4
5
6
7
8
9
1,5  
1,5  
2
0
2
0
2
5
The average value of the Charlson index of the patients examined by us was 3.97 ± 2.0  
points (3.75 ± 2.3 points in men and 4 ± 1.9 points in women), which makes it possible to  
predict the 10-year survival rate of only 53% of the examined and is a poor prognostic  
criterion.  
The average values of adherence to the implementation of medical recommendations  
of the examined patients with arterial hypertension and comorbidity are presented in Table  
3.  
Table 3. Average values of adherence to treatment in patients with arterial hypertension and  
comorbidity (M ± δ)  
All patients  
n = 138)  
Men  
(n = 40)  
Women  
(n = 98)  
Commitment categories, points  
Adherence to drug therapy  
(
71,2±17,2  
41,4±13,7  
70,5±20,5  
38,0±16,8  
71,5±16,0  
42,9±12,2  
Commitment to medical support  
Commitment to lifestyle  
modification  
4
4,1±10,4  
42,0±12,9  
55,3±16,4  
44,9±9,2  
57,1±9,9  
Treatment adherence  
56,7±12,0  
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DOI: http://dx.doi.org/10.46925//rdluz.33.18  
Adherence to drug therapy in our study was high in 50% of men and 38.8% of women,  
medium - in 30% of men and 42.8% of women, low - in 20% of men and 18.4% of women.  
Adherence to medical care was high in 10% of men and 2% of women, moderate in 5% of men  
and 14.3% of women, low in 85% of men and 83.6% of women. Adherence to lifestyle  
modification reached the average level in 20% of men and 22.4% of women, low - in 80% of  
men and 77.5% of women. The resulting indicator is adherence to treatment, which was high  
only in 5% of men and 2% of women, medium - in 55% of men and 73.5% of women, low - in  
4
0% of men and 24.5% of women (Figure 1).  
Treatment adherence rates in patients with arterial hypertension and  
comorbidity (%)  
1
00  
90  
80  
70  
60  
50  
40  
30  
20  
10  
0
Men  
Women  
low average high  
Figure 1. Levels of adherence to treatment in patients with arterial hypertension and  
comorbidity (%)  
Of practical interest is the fact that 33.3% of the patients we interviewed (40% of men  
and 30.6% of women) took medications only during the period of hospitalization. The  
incidence of low adherence to medical recommendations was more pronounced in men and  
turned out to be the highest in the categories of adherence to medical care and lifestyle  
modification (Fig. 2).  
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DOI: http://dx.doi.org/10.46925//rdluz.33.18  
Frequency of low adherence to medical recommendations (%)  
90  
80  
70  
60  
50  
40  
30  
20  
10  
0
Adherence to drug therapy Commitment to medical Commitment to lifestyle  
support modification  
Treatment adherence  
men women  
Figure 2. Frequency of low adherence to medical recommendations in patients with arterial  
hypertension and comorbidity (%)  
Thus, the group of patients examined by us was characterized by a high comorbidity  
index and unsatisfactory adherence to treatment. The methodology used to quantify  
adherence to treatment (National recommendations of the Russian Scientific Medical  
Society of Physicians for the quantitative assessment of adherence to treatment, 2017) allows  
us to manage therapy taking into account the identified levels of adherence in a particular  
patient. This approach will help to achieve the maximum possible result of medical  
interventions. Вased on this, it is possible to recommend the introduction of a questionnaire  
to quantify adherence to treatment into the practice of managing patients with hypertension  
and comorbidity. To increase the effectiveness and adherence to treatment, it is necessary to  
systematically work with patients, taking into account their level of adherence.  
Correlation analysis revealed statistically significant negative associations of weak  
strength between the number of drugs used and adherence to treatment (r = -0.11, p <0.0001),  
mainly due to adherence to drug therapy (r = -0.12, p < 0.0001) and medical support (r = -0.23,  
p <0.0001). Multidirectional correlations were obtained between age and individual  
categories of adherence to treatment: negative - between age and adherence to drug therapy  
(
r = -0.21, p <0.001), between age and adherence to medical care (r = -0.27, p <0.0001) and  
positive - between age and commitment to lifestyle modification (r = 0.18, p <0.0001).  
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DOI: http://dx.doi.org/10.46925//rdluz.33.18  
Conclusion  
Adherence to treatment in almost a third of the patients we surveyed was low. The  
lowest rates of adherence were found to medical support and lifestyle modifications, the  
highest were found to drug therapy. According to the results of our study, the factors  
influencing adherence, efficacy and tolerability of treatment includes age and the number of  
drugs taken. To increase the effectiveness and adherence to treatment, it is necessary to  
systematically work with patients, taking into account their level of adherence. The  
introduction into the practice of managing patients with arterial hypertension and  
comorbidity of the questionnaire to quantify adherence to treatment will increase the  
adherence of patients to the implementation of medical recommendations.  
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1
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