IJCS | Volume 33, Nº2, March / April 2020

122 Araújo & Aras Junior Therapeutic adherence and resistant hypertension Int J Cardiovasc Sci. 2020; 33(2):121-130 Original Article is an important and challenging cause, since studies indicate that 50-80% of patients with systemic arterial hypertension (SAH) do not adhere to the medications. 1 The RH treatment — as well as that of non-resistant hypertension — is based on non-medication and medication measures. Drug therapy consists of the association of antihypertensives with action on the main pathophysiological mechanisms of BP elevation. Thus, a diuretic, renin-angiotensin-aldosterone system inhibitor –ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB) – and a calcium channel blocker (CCB) should be initially prescribed at full tolerated doses and adequate intervals. 1,3 Studies indicate that,withgoodadherence to treatment, there is better clinical evolution regarding minimizing and/or postponing cardiovascular complications, in addition to more effective control of BP. 1,3 Therefore, failure to adhere to the proposed therapy, being one of the main obstacles to the control of BP, 3,4 contributes to higher morbidity and mortality. There are several strategies for the detection and evaluation of therapeutic adherence, but without any consensus. 5 Questionnaires based on patient reports, despite low sensitivity and accuracy, are the most commonly usedmethod due to simplicity and low cost. 4,5 Of these, the most used in Brazil 4 is the Morisky-Grenn test (TMG), 6 composed of questions that can easily be inserted in the medical interview. 5,7 In addition, it has been shown to be useful for identifying patients that either adhere or not to the treatment, 5 with sensitivity of 43.6% and specificity of 81%. 4 In view of the high prevalence of poor adherence to antihypertensive treatment and considering the impact on morbidity and mortality due to impaired BP control, it is important to analyze this aspect in the follow-up of patients with SAH. Special attention is paid to individuals with RH, since they require more antihypertensive agents, which may contribute to poor adherence to treatment. Therefore, the main objective of the study is to determine the degree of therapeutic adherence of patients with RH followed in a referral clinic through the Morisky scale and to evaluate its relationship with the epidemiological, anthropometric and clinical profile of these patients, as well as with the cardiovascular outcomes, complications and comorbidities associated with SAH. Secondary objectives are to estimate the prevalence of pseudoresistance and to devise strategies to improve therapeutic adherence. Methods Study design and sample The study was an observational retrospective cohort based on interview with patients. The convenience sample included individuals aged 18 years and older, followed between 2012 and 2017, at the service of Severe Hypertensive Cardiovascular Disease of Ambulat rio José Maria de Magalh es Neto Ambulatory, belonging to Complexo Hospitalar Universitário Professor Edgard Santos (Complexo-HUPES), Universidade Federal da Bahia (UFBA), who accepted to participate in the study by providing written Informed Consent. There were no exclusion criteria. Analyzed variables For all patients included in the study, a standardized questionnaire was used to collect data on therapeutic adherence through the Morisky-Grenn test, as well as epidemiological data (sex, age, education and ethnicity), anthropometric data (body mass index [BMI], systolic BP and diastolic BP) and clinical data (time of diagnosis of hypertension, time of follow- up in the outpatient clinic, alcoholism, current and previous smoking, antihypertensive drugs in use, comorbidities and complications — prior acute myocardial infarction [AMI], prior stroke, diabetes mellitus [DM], dyslipidemia and metabolic syndrome). In addition, data from routine laboratory exams and 24-hour ambulatory blood pressure monitoring (ABPM) were evaluated. BP measurement was performed according to the recommendations of the Brazilian Society of Cardiology. 1 Patients were stratified according to the Morisky- Grenn test in having good therapeutic adherence (6 to 8 points) or poor therapeutic adherence (5 points or less). In both subgroups, the epidemiological, anthropometric and clinical profiles, presence of comorbidities and complications, bloodpressure levels and antihypertensive medications in use were analyzed. Statistical analysis The parameters studied were evaluated in terms of the type of distribution using the D’Agostino-Pearson statistical test. The data collected are presented as mean and standard deviation (mean ± SD) for continuous variables with normal distribution and as median and interquartile range for non-normal continuous variables.