Quality of life in patients with arterial hypertension - possibilities of complex pharmacotherapy.
Bukovyna State Medical University, "University Clinic" Emergency Medical Hospital, Department of Internal Medicine, Clinical Pharmacology and Occupational Diseases
In the article, a comparative assessment of the dynamics of the quality of life in patients with arterial hypertension based on the results of the SF-36 questionnaire was carried out, depending on the method of treatment - basic antihypertensive therapy and complex therapy with the addition of the drug "Valerin Cardio" (Production of VITERA LLC, Ukraine).
It was established that in the case of prescribing complex antihypertensive therapy with the inclusion of the drug "Valerin Cardio", a significant increase in the quality of life was noted on scales that form both physical and psychological components of health (PF, RP, BP, GH, RE, VE, MH, SF ) compared to patients who received only standard medical therapy, where an unreliable increase in indicators of physical activity, physical and emotional limitation of role functions, as well as general perception of health was noted.
Relevance of the problem (implementation)
Arterial hypertension (AH) is one of the most important medical and socio-economic problems in cardiology, acting as the main risk factor for cardiovascular diseases. Therefore, pharmacotherapy of hypertension remains one of the key points of the recommendations of the European Society of Hypertension and Cardiology . Modern hypertension therapy is aimed, first of all, at preventing cardiovascular catastrophes. On the other hand, nowadays more and more attention is paid to the quality of life (QoL) of patients . The assessment of acute respiratory distress syndrome is a new and promising area of medicine that allows you to accurately assess a patient's health impairment, clearly visualize the essence of his clinical problem, determine the most rational method of treatment, and also assess the expected result according to parameters that are at the junction of the scientific approach of specialists and sub objective point of view. patient, while analyzing all components of health [13, 14]. Also, a high level of quality of life is the key to successful treatment of arterial hypertension.
At the same time, studies aimed at studying the quality of life in patients with GC, evaluating the possibilities of not only basic antihypertensive therapy, but also complex pharmacotherapy capable of changing the level of physical, mental, and emotional comfort, and influencing the quality of life of cardiac patients, have been conducted to date not enough [1, 3, 6]. Thus, individualized pharmacotherapy of arterial hypertension should involve solving a number of tactical tasks that take into account not only the symptoms of hypertension, reducing the frequency of hypertensive crises, prevention of cardiovascular complications, but also improving the quality of life (QoL) in patients with arterial hypertension.
The aim of the study
To analyze the change in quality of life indicators in patients with arterial hypertension according to the SF-36 questionnaire, as well as their dynamics against the background of the appointment of basic antihypertensive therapy in comparison with complex therapy when the drug "Valerin Cardio" is included in the treatment regimen.
Pharmacodynamics of the drug
The pharmacological effect of "Valerin Cardio" is determined by the bioactive properties of the medicinal plants included in this preparation. Melissa officinalis L. contains essential oils that have a sedative effect; olsanic and ursolic acids in lemon balm prevent drops in blood pressure [6, 10]. Medicinal valerian (Valeriana officinalis L.) has a sedative, tranquilizing effect on the central nervous system, indirectly regulating cardiac activity . Fenugreek (Leonurus cardiaca L.), due to the presence of flavonoids and steroid glycosides in its composition, reduces the excitability of the nervous system, slows down the rhythm and increases the force of heart contractions, has a sedative, hypotensive and general cardiotonic effect . Passiflora contains passiflorin, which has a calming effect on the nervous system, expands coronary vessels, improving heart trophicity [5, 9]. Magnesium regulates heart rhythm, lowers blood pressure. Vitamin B6 improves the assimilation of magnesium and its metabolism, has the ability to fix magnesium in the cell. Vitamin C increases the immunity and resistance of the body, contributes to the reduction of atherogenic fractions of lipoproteins. Vitamins B1, B2, B6, B12 are necessary for normal metabolism, reduce the risk of developing cardiovascular diseases.
Materials and methods
51 patients with hypertension were examined (average age - 46.15±7.4 years). The following methods were used to verify the diagnosis: clinical-instrumental (survey, objective research, blood pressure level registration, electrocardiography, echocardiography), as well as clinical-laboratory methods. Verification of the diagnosis and stage of hypertension was carried out using the criteria recommended by the European Society of Hypertension and Cardiology (ESH - ESC Guidelines, COMMITTEE, 2013) .
The Medical Outcomes Study Short Form 36 questionnaire (SF-36, Russian version, created and recommended by the International Center for Quality of Life Research) was used to assess the quality of life (QoL) of patients with hypertension. This questionnaire allows to assess the patient's subjective satisfaction with his physical and mental condition, social functioning. Patients were asked to fill out the SF-36 questionnaire on the day of admission, as well as after 2 weeks of inpatient treatment on the background of complex pharmacotherapy. SF-36 provides an opportunity to assess QOL on eight scales: physical functioning - PF (Physical Functioning), role functioning due to physical condition - RP (Role-Physical Functioning), bodily pain - BP (Bodily pain), general health - GH (General Health), vital activity - VT (Vitality), social functioning - SF (Social Functioning), role functioning caused by emotional state - RE (Role-Emotional) and mental health - MH (Mental Health) .
All patients were prescribed basic antihypertensive therapy (ramipril - 20 people, enalapril - 31 people) in an individually tolerated dose, depending on the clinical course of the disease and the level of initial blood pressure (BP). After the initial examination and the appointment of basic therapy, the patients were divided into groups of controlled observation: group 1, in which only basic antihypertensive therapy was used (n=24), as well as the group of complex pharmacotherapy, in which, against the background of basic therapy, the drug "Valerin Cardio" was prescribed at a dose 500 mg 2 grams. within 15 days (n=27). The difference in the distribution of patients receiving ramipril and enalapril between groups 1 and 2 was not reliable.
The Statistica for Windows version 8.0 package (Stat Soft Inc., USA) was used for statistical data analysis. The studied indicators had a normal distribution, therefore, they are presented in the form of M±m, where M is the average, m is the standard deviation. At p<0.05 (according to Student's t test), the difference in indicators was considered statistically significant .
Research results and their discussion
At the first visit of the patients, in addition to the general clinical one, an instrumental examination was carried out, patients' informed consent cards and the SF-36 questionnaire were filled out .
The measurement model underlying the construction of the SF-36 has 3 levels: 1) items (questions); 2) eight scales, each of which combines together from 2 to 10 points; 3) two total measurements that unite the scales together. When processing the results, the answers to all 36 items form 8 scales. Items that apply to each specific scale are summed and converted to a value from 0 to 100, where 100 is the maximum value and 0 is the minimum. Higher scores mean higher health.
1. Physical Functioning (PF) - reflects the degree to which health limits the performance of physical activities (self-care, walking, climbing stairs, carrying loads, etc.).
2. Physical limitation of role functions (Role limitations due to physical health - RP) - influence of physical condition on role functioning (work, performance of everyday activities).
3. Physical pain (Body Pain – BP) – the intensity of pain and its impact on the ability to engage in daily activities, including work around the house and outside the home.
4. General perception of health (General Health – GH) – patients' assessment of their current state of health and treatment prospects.
5. Emotional limitation of role functions (Role limitations due to emotional problems – RE) - involves an assessment of the degree to which the emotional state interferes with the performance of work or other daily activities (including large expenditures of time, reduction of the volume of work, reduction of its quality, etc.). ).
6. Vital energy (VE) – refers to the feeling of being full of strength and energy or, on the contrary, exhausted.
7. Mental Health (MH) – characterizes mood (presence of depression, anxiety, general indicator of positive emotions).
8. Social Functioning (SF) - is determined by the degree to which a physical or emotional state limits social activity (communication).
The scales are grouped into two indicators: "physical component of health" and "psychological component of health":
I. Physical health component (Physical health – PH). Scale components: 1) physical functioning;
2) role functioning caused by physical condition; 3) pain intensity; 4) general state of health.
II. Psychological component of health (Mental Health – MH). Scale components: 1) mental health; 2) role functioning caused by emotional state; 3) social functioning; 4) vital activity.
Each item was used to score only one of the scales. On the basis of 8 scales, a total assessment of physical and mental health was carried out. The results of the SF-36 are presented in Table 1. The analysis of the obtained data showed that the short-term health is reduced in all patients with hypertension according to all scales of the SF-36 questionnaire. The lowest indicators were obtained on the scales forming the physical component of health (RP and BP), and the difference in initial indicators between groups on all scales was unreliable (p1>0.05). The initial results indicate that the physical condition of patients with arterial hypertension significantly affects their activity and everyday role activities.
Quality of life of hypertensive patients with data from the SF-36 questionnaire in the dynamics of basic therapy, as well as complex therapy with the inclusion of the drug "Valerin Cardio"
p - degree of reliability of the difference of indicators in the dynamics of treatment;
p1 - reliability of differences between indicators of quality of life in groups 1-2 before treatment;
p2 - reliability of differences between indicators of quality of life in groups 1-2 after treatment.
Data of averaged indicators on the scales of role functioning caused by emotional state; mental health; of social functioning showed that hypertensive disease increases the disturbance of the patient's quality of life, also negatively affecting the psychological component of health and contributes to the limitation of social contacts, the limitation of the performance of daily work, due to the deterioration of emotional well-being in such patients.
In the dynamics of treatment, results were obtained that indicate that the quality of life of patients with arterial hypertension directly depends on the clinical course of the disease. In particular, an increase of 6.34% (p>0.05) in the level of "Physical activity" in the basic therapy group was noted, in the group where "Valerin Cardio" was additionally prescribed - by 24.2% (p<0.05) ). According to the scale "The role of physical problems in limiting life activities", an increase of 12.0% (p>0.05) and 60.6% (p<0.05) was obtained, respectively. The level of quality of life according to the Physical pain parameter increased by 1.85 (group 1, p<0.05) and 2.35 times (group 2, p<0.05). "General perception of health" increased by 7.9% in the basic therapy group (p>0.05) and by 38.6% in the complex therapy group (p<0.05). According to the scale "The role of emotional problems in limiting life activities", unreliable dynamics were noted among patients who received only basic therapy (6.8%, p>0.05), with reliable changes in patients who were additionally prescribed "Valerin Cardio" (25, 8%, p<0.05). The level of "Vital force" significantly increased in both groups (39.9% and 43.1%, p<0.05). According to the "Mental health" parameter, reliable dynamics were obtained both in the group of basic therapy (30.4%, p<0.05) and in the group of complex therapy (44.2%, p<0.05), with more significant changes in patients who were prescribed the drug "Valerin Cardio" in complex treatment (p2<0.05). According to the level of "Social functioning", reliable results were obtained in both groups (30.4 and 44.2%, p<0.05), although there was no difference between the cohorts (p2>0.05).
The results presented in the article are based on a comparative assessment of the quality of life in patients with arterial hypertension in the dynamics of basic antihypertensive therapy, as well as complex therapy with the inclusion of the drug "Valerin Cardio".
The analysis included the results of the examination of 51 patients with arterial hypertension who were admitted to the therapeutic department No. 1 of the "University Clinic" on the basis of the emergency medical care hospital in Chernivtsi. The clinical course of hypertension in the main and control groups was evaluated, as well as the comparative characteristics of the dynamics of the quality of life of patients based on the results of the SF-36 questionnaire. The comparison was made depending on the method of pharmacotherapy - basic antihypertensive therapy and complex treatment with the addition of the drug "Valerin Cardio".
Thus, when assessing the dynamics of the quality of life of patients with arterial hypertension, it was established that in the case of prescribing complex antihypertensive therapy with the inclusion of the drug "Valerin Cardio", a significant (p<0.05) increase in the level of quality of life was noted on scales that form both physical and psychological components of health (PF, RP, BP, GH, RE, VE, MH, SF) compared to patients who received only standard drug therapy, where an unreliable increase in indicators of physical activity, physical and emotional limitation of role functions, as well as general perception of health. As a result, after the dynamic observation of patients with arterial hypertension against the background of prescribing the drug "Valerin Cardio", a significant improvement in the quality of life according to the SF-36 questionnaire was noted, which was accompanied by a decrease in irritability, an increase in emotional stability, and an increase in work capacity. Thus, the drug can be recommended in the complex therapy of such a stress-dependent disease as hypertension.
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