Table 2.
Characteristics of included studies on adherence to antihypertensive therapy in adult population in Russia from 2000 to 2017
| Reference | Year of publication | Study setting | Participant selection criteria | Design | Sample size | Age (years) | HT gradea | Critical appraisal/quality assessment of findings (a) Strengths (b) Weaknesses |
|---|---|---|---|---|---|---|---|---|
| Ageev et al. [11] | 2008 | Patients who visited outpatient department of the Russian Cardiology Scientific and Production Center |
Men or women older than 18, with SBP 140–179 mmHg, DBP 99–100 mmHg, high cardiovascular risk, not taking of ACE inhibitors and diuretics, without secondary HT, heart failure, renal and hepatic impairment, insulin-treated DM. Recruitment process not described |
Randomized non-blinded controlled intervention study | 60 | 62.5 ± 2.2 | 1–3 |
(a) prospective study, follow up period 6 mth; (b) small sample size, incorrect DBP level in inclusion criteria |
| Kobalava et al. [12, 13] | 2011 | Patients attending 240 cardiologists in 17 Regions | Men or women with uncontrolled HT, non-adherent, absence of contraindications to ACE inhibitors taking, no eligibility to receive MAS | Randomized non-blinded controlled intervention study | 906 | 56.2 ± 10.6 (female)/ 54.9 ± 10.9 (male) | Uncontrolled HTb |
(a) multicenter study, follow up period 12 mth, big sample size; (b) including only non-adherent patients |
| Sarycheva et al. [14] | 2017 |
Single outpatient clinic in Moscow Region. 300 patients have been examined before 150 patients included |
Men or women aged 40–65, with ineffective treatment of HT and dyslipidemia, SBP > 140 mmHg, DBP > 90 mmHg, without IHD, DM and other severe diseases | Randomized non-blinded controlled intervention study | 150 | 40-65y | HT patients with high cardiovascular risk |
(a) follow up period 12 mth; (b) there are no basic data of adherence |
| Fofanova et al. [15] | 2008 | Patients who visited outpatient department of the Russian Cardiology Scientific and Production Center | Men or women older than 18, with SBP 140–179 mmHg, DBP 99–100 mmHg, not taking of ACE inhibitors and diuretics, without secondary HT, heart failure, renal and hepatic impairment, insulin-treated DM. Recruitment process not described | Randomized non-blinded controlled intervention study | 60 |
61.2 ± 1.8 (female)/ 61.8 ± 2.1 (male) |
1–2 |
(a) patients with high and very high cardiovascular risk are included, for which adherence to therapy is particularly important, follow up period 6 mth; (b) small sample size, incorrect DBP level in inclusion criteria |
| Karpov et al. [16] | 2013 | Patients attending any of 700 cardiologists in 51 Regions, each recruiting 3 patients | Men or women older than 18, with uncontrolled HT on treatment. Recruitment process not described | Prospective observational intervention study | 2120 | 22–88 y | 2–3 |
(a) big sample size, multicenter study; (b) relatively short follow up period 3 mth and no control group |
| Glezer et al. [17] | 2016 | Patients attending 197 physicians in 48 Regions | Men or women aged 18–79, with essential HT, SBP ≥140 mmHg, DBP ≥90, but <110 mmHg | Prospective observational intervention study | 940 | 56.5 ± 11.5 | 1–2 |
(a) big sample size, multicenter study; (b) relatively short follow up period 3 mth, no control group |
| Glezer et al. [18] | 2015 | Patients attending 243 physicians in 51 Regions | Men or women older than 18, with HT taking 2 or more antihypertensive drugs who have not reached their BP target, SBP 140–179 mmHg, DBP 90–109 mmHg, without contraindications to ACE inhibitors and calcium channel blockers | Prospective observational intervention study |
1351 included, 1061 completed the protocol |
59.4 ± 11.1 | Essential HT |
(a) big sample size, multicenter study; (b) relatively short follow up period 3 mth, no control group |
| Glezer et al. [19] | 2016 | Patients attending 442 physicians in 29 cities | Men or women older than 18, with HT on treatment who have not reached their BP target | Prospective observational intervention study | 1969 | 60.1 ± 0.3 | No data |
(a) big sample size, multicenter study; (b) relatively short follow up period 3 mth, no control group |
| Kagramanyan [20] | 2015 |
Not stated The author is affiliation at Yaroslavl State Medical University |
Men or women aged 18–80, with grades 1–3 of HT, who visited the Municipal Clinical Hospital | Prospective observational intervention study | 50 |
64.06 ± 0.49 (female)/ 61.88 ± 1.28 (male) |
1–3 |
(a) studying of adherence in patients with 3 different socially significant nosologies - HT, asthma and alcohol abuse; (b) small sample size, large age range, the real number of HT patients is represented incorrectly |
| Kaskaeva et al. [21] | 2015 | Not stated | Male patients aged 20–64 with grades 1–3 of HT. Recruitment process not described | Non-randomized comparison of 3 groups | 250 | 20–64 y (male) | 1–3 |
(a) patients of employable age + relationship adherence to job; (b) described as randomized but groups selected on basis of employment: train drivers (112), other railway workers (50), non-railway workers (88) |
| Ushakova et al. [22] | 2005 | Regional cardiology clinic in Ivanovo city | Men or women with grade 2 of HT on treatment, without IHD and DM | Prospective observational intervention study | 52 | 50.08 ± 7.25 | 2 | (b) small sample size, no control group, patients with grade 2 of HT only included |
| Chazova et al. [23] | 2014 | Patients who visited outpatient department of the Russian Cardiology Scientific and Production Center | Recruitment process not described | Prospective observational intervention study | 193 | 60.3 ± 8.0 | No data |
(a) scope of sessions with patients, duration of sessions and number of the studying patients in group corresponded to the standards approved by the Ministry of Health, it is important for working at outpatient care settings; (b) the control group is formed from abandoning the patient education, the number of patients in the control group is 2 times less than in the intervention group (65:128), short follow up period 6 weeks |
| Fofanova et al. [24] | 2009 | Patients attending 185 cardiologists in 84 policlinics of Moscow | Men or women with SBP 140–179 or DBP 99–100 mmHg, not taking calcium channel blockers | Cross-sectional | 4816 | 62.2 ± 0.2 | 1–2 |
(a) big sample size; (b) incorrect DBP level in inclusion criteria, only possible to extract baseline data |
| Donirova et al. [25] | 2012 | Ambulatory care facility | Men or women with HT on treatment | Cross-sectional | 74 | 18 y and older | No data | (b) small sample size (14 vs 60) |
| Loukianov et al. [26] | 2017 | Patients attending 185 physicians or cardiologists of the same from 3 randomly selected outpatient clinics of Ryazan and the Ryazan region in March–May 2012 (consecutive inclusion of all who applied from March 01 to May 27) | Patients older than 18, with combination of IHD, HT, chronic heart failure, permanent residence in the Ryazan and the Ryazan region | Register | 2303 |
70.3 ± 10.7 (ppl with history of MI), 69.9 ± 11.0 (ppl without history of MI) |
1–3 |
(a) collection of adherence data using MMAS-4 in a large outpatient register (b) all patients, irrespective of history of MI, had complex pathology of IHD, HT and chronic heart failure. Therefore it is impossible to estimate independent association between HT and adherence. |
| Fofanova et al. [27] | 2014 | Patients who visited outpatient department of the Russian Cardiology Scientific and Production Center | Men and women with HT and examined by psychiatrists | Cross-sectional | 161 |
19–75 (female)/ 53.4 ± 11.4 (male) |
1 |
(a) assessment of adherence and psychosomatic aspects; (b) groups selected on basis of adherence to treatment: low adh – 131 ppl, high adh – 30 ppl |
| Soboleva et al. [28] | 2012 | Regional clinical hospital and ambulatory care facility | Patients with grades 1–3 of HT and cardiovascular disease. Recruitment process not described. | Cross-sectional | 242 | 18 y and older | 1–3 | (b) only possible to extract baseline data |
| Oganov et al. [29] | 2007 | Patients attending 512 physicians in 20 cities | Men or women with HT and/or IHD | Cross-sectional | 2496 | 18 y and older | 1–3 |
(a) big sample size; (b) no prospective stage |
| Olejnikov et al. [30] | 2014 |
Not stated The authors are affiliation at Penza State Medical University |
Men or women older than 60, with grades 1–2 of HT. Recruitment process not described |
Cross-sectional | 75 | 66.6 ± 4.7 | 1–2 |
(a) studying adherence in the elderly; (b) non-standard way of MMAS-4 analyze, small sample size, only possible to extract baseline data |
| Smirnova et al. [31] | 2012 | Ambulatory care facility | Patients aged 45–75, with grades 1–2 of HT. Recruitment process not described | Randomized non-blinded controlled intervention study | 60 | Intervention group: 62 ± 9.4, control group: 63 ± 8.9 | 1–2 |
(a) complex intervention on adherence; (b) small sample size, relatively short follow up period – 3 mth |
| Vologdina et al. [32] | 2009 | Not stated | Men and women with IHD and grades 1–2 of HT. Recruitment process not described | Randomized non-blinded controlled by closed envelope method | 70 |
80.7 ± 2.7 (female)/ 80.3 ± 2.5 (male) |
1–2 |
(a) studying adherence in the elderly; (b) small sample size, relatively short follow up period – 3 mth |
| Sviryaev et al. [33] | 2006 | Ambulatory care facility | Men or women older than 18, with grades 1–2 of HT with irregular therapy | Prospective observational intervention study | 115 | 51.3 ± 9.6 | 1–2 |
(a) follow up period 6 mth; (b) no control group, numerical indicators of adherence level aren’t presented in the publication |
| Morozov et al. [34] | 2010 | The authors are affiliation at Russian military medical Academy, St. Petersburg | Patients with grades 1–2 of HT | Cross-sectional | 86 | 30–73 y (54 ± 4,8) | 1–2 | (b) only possible to extract baseline data, non-standard way of MMAS-4 analyze |
| Kotovskaya et al. [35] | 2015 | Patients attending 830 physicians in 113 cities | Men or women older than 18, with uncontrolled HT taking ACE inhibitors or angiotensin receptor blockers | Prospective observational intervention study | 2435 | 59.3 ± 11.2 | Uncontrolled HTb |
(a) big sample size, multicenter; (b) MMAS modified with 2 additional questions, no control group, relatively short follow up period – 3 mth |
| Panov et al. [36] | 2015 | Federal Medical Research Center, St. Petersburg | Patients with grades 1–2 of HT and IHD | Prospective observational intervention study | 60 | 57.65 ± 1.59 | 1–2 |
(a) follow up period - 12 mth; (b) small sample size |
| Oschepkova et al. [37] | 2004 | Patients who visited outpatient department of the Russian Cardiology Scientific and Production Center | Men and women aged 30–71, with grades 1–2 of HT, without MI, stroke, heart failure, heart arrhythmias. Recruitment process not described | Randomized non-blinded controlled intervention study | 30 | 54 ± 11 | 1–2 |
(a) home BP devices as a way to increase adherence; (b) described as randomized but main group – 19 ppl, control group − 11, small sample size |
| Kontsevaya et al. [38, 39] | 2015 | Patients who visited Outpatient Cardiology Clinic | Men or women with grades 1–3 of HT | Cross-sectional | 1419 | 61.94 ± 0.26 | 1–3 |
(a) big sample size, a large number of factors associated with adherence: sociodemographic, clinical, etc.; (b) no prospective stage |
| Kopnina et al. [40] | 2008 | Not stated | Patients with HT. Recruitment process not described | Cross-sectional | 30 | 51 ± 1.14 (female) | 2 | (b) small sample size, only women are included in the study |
| Sergeeva et al. [41] | 2012 | Patients of the cardiological and endocrinological department of the Regional Clinical Hospital |
Men and women with HT or HT + DM. Recruitment process not described |
Cross-sectional | 190 |
With HT: 47.6 ± 0.4, with HT + DM: 44.7 ± 0.2 |
1–3 |
(a) association of adherence with hypertensive crisis was shown; (b) no data on validation of bespoke questionnaire |
ACE inhibitors, angiotensin converting enzyme inhibitors, CVD cardiovascular diseases, DBP diastolic blood pressure, DM diabetes mellitus, HT arterial hypertension, IHD ischemic heart disease, MAS Medicine Assistance Scheme, MI myocardial infarction, MMAS-4 4-item Morisky Medication Adherence Scale, mth months, ppl people, SBP systolic blood pressure
a Definitions of office blood pressure levels (mmHg): grade 1 hypertension: 140–159 and/or 90–99; grade 2 hypertension: 160–179 and/or 100–109; grade 3 hypertension: ≥180 and/or ≥ 110
b Uncontrolled HT was defined with patients not taking a previously prescribed therapy, registered in the medical records or insufficiently effective therapy