The investigation of determinants of drug compliance among hypertensive patients in Yerevan, Armenia

Abstract

Hypertension is a highly prevalent risk factor for cardiovascular diseases, which are still the major "killers" in Western countries. Hypertension leads to atherosclerotic cardiovascular disease, which includes the coronary heart disease, particularly, myocardial infarction and stroke. Ongoing control and life-long therapy are extremely important for prevention of adverse outcomes of hypertension. The mortality from cardiovascular diseases due to hypertension accounts for almost 50% of all deaths in US. [ 2]. Eighteen years follow up data on subjects from the Framingham Heart Study show that hypertension preceded the development of coronary heart failure in 91% of CHF cases. Data further indicate that uncontrolled hypertension increases the risk of congestive heart failure twofold among men and threefold among women, and that the risk of CHF increases with the severity of hypertension.[19]. Data from clinical trials, conducted in USA and in the other countries show that control of high blood pressure can reduce the incidence of CHF and stroke by as much as 55%.[18]. As a result of awareness, treatment and control the mortality from cardiovascular diseases due to hypertension declined in past years in US.[7]. Conversely, in Armenia the mortality from cardiovascular diseases caused by uncontrolled hypertension is still high and consist 52.3% of all causes of deaths.[17]. According to data of MOH the mortality from cardiovascular diseases have trends to increase: from 339 per 100,000 in 1995 year to 354 per 100.000 in 1998y. The aim of proposed study is to identify the determinants that influence on appropriate drug compliance of hypertensive patients in Yerevan. This project proposes to conduct the survey among hypertensive patients in Yerevan during the March of 2000y in order to assess the real situation with drug compliance among them. A preliminarily qualitative research was conducted during the August - September 1999y for determining the main behavioral and environmental factors and for better understanding the contribution of each factor or the association of the factors on patients drug compliance. Inclusion criteria were following: Yerevan residents, both male and female older than 45years, enrolled in the local polyclinics as hypertensives. There were conducted 21 K informant in depth interviews, using a developed at baseline and slightly modified after pretesting Field Guide. Qualitative stage was important and useful for generate ideas and in depth understanding the behavioral patterns that lead to drug compliance among hypertensives. On the base of gathered information was developed the questionnaire for proposed "stage 2" - survey. The questionnaire also was pretested and 3 versions were examined The further quantitative research proposed to test the hypotheses developed from qualitative part. The results of the survey will provide health policy makers with additional precise information about drug compliance, will give the recommendations to improving existing drug compliance practices by financial support based on real estimation of necessary expenditures and will guide in a developing a comprehensive antihypertensive program in Armenia.