Real Data on the Hypertension Treatment in Patients with Metabolic Syndrome and/or Type 2 Diabetes Mellitus: Analysis of the Therapy Effectivity and the Therapeutic Inertia in Outpatient Study

We have analysed the database of 1,595 consecutive patients visiting our department of cardiology
and internal medicine clinic in 2005-2014. The analysis included 13,990 visit records and the average
number of visits per patient was 8.5 ± 7.0. Our goals were to evaluate the effectivity of hypertension
treatment as for drug choice, decrease of sBP and dBP associated with certain drug, drug
combination and therapeutic inertia in patients with metabolic syndrome and/or diabetes mellitus. The
final number of patients for analysis who fulfilled the inclusion criteria for interpenetration of both
diagnostic circles was 570.
Results: 15% of patients were treated using hypertension monotherapy, 70% of patients were treated
using 2- to 4-drug combination therapy, and 15% of patients were treated using 5- to 6-drug
combination. The drugs usedmost frequently were perindopril (perin), nitrendipine (nitre), amlodipine
(amlo), telmisartan (telmi), hydrochlorothiazide (hydro), rilmenidine and nebivolol (used >100
patients). The most significant decrease of sBP was associated with treatment by nitre, hydro, telmi
and urapidil (>19 mmHg).The most significant decrease of dBP was associated with treatment by
nitre, hydro, telmi and verapamil (>10 mmHg). The most significant decrease of both sBP and dBP
was associated with treatment using 3-drug combination of telmi+hydro+spironolactone (41 and
16mmHg, respectively), telmi+hydro+nitre (34 and 15 mmHg, respectively) and telmi+hydro+urapidil
(34 and15 mmHg, respectively). At the last visit, 281 out of 413 patients at the first visit had sBP >140
mmHg (68%) i.e. sBP control was 32%. At the last visit 76 patients out of 217 at the first visit had dBP
>90 mmHg (35%) i.e. dBP control was 65%.
Therapeutic inertia was calculated by evaluating the proportion of visits at which sBP was above
the target for eligible visits minus the proportion of visits where the change was made in
antihypertensive treatment (AHT), either medication type or dose, over the number of eligible visits,
with the resultant value multiplied by the mean of difference between actual sBP and target value at
clinic visits:
TIQ= ((%>TARGET - %Δ AHT/visits)/visits)* mean sBP- target sBP.
TIQ was counted at first 200 consecutive patients and the average value was 57.30 ± 147.20.
Conclusion: The study presents the real-life data concerning the difficulties in hypertension treatment
in patients with concomitant metabolic syndrome and/or 2 type diabetes mellitus. SBP was controlled
at 32% patients only. The study results allow evaluating effectivity of hypertension treatment as for
drug choice, decrease of sBP and dBP associated with a certain drug, a drug combination, and
therapeutic inertia in patients with metabolic syndrome and/or diabetes mellitus. The score of
therapeutic inertia evaluation should contribute to the improvement of hypertension control and should
be a part of the quality assessment in hypertension management.