Possibilities to Improve Results of Management for Patients with Arterial Hypertension and Obesity in Primary Care

Arterial hypertension (AH) and obesity are important problems of the working population of the planet, which need to be addressed by the health care system. In Ukraine, obesity among children and adolescents is detected in 13.5 people per 100,000 of population, which according to statistical data is significantly lower than in European countries. Basically, these differences can be explained by the lack of attention of parents, family doctors, society and the health care system as a whole to this problem. More than half of patients with AH, which is the main risk factor for the development of potentially lethal complications of cardiovascular diseases, have concomitant obesity of varying degrees. Adipose tissue, especially abdominal tissue, has a significant impact on the endocrine, immunological homeostasis of the body, and negatively affects lipid and carbohydrate metabolism, maintains a systemic inflammation process, thus contributing to the progression of atherosclerosis, metabolic syndrome and related diseases. The objective: to improve the results of managing patients with AH and obesity in primary care by applying a holistic approach to lifestyle modification and pharmacotherapy based on assessing patient’s readiness for changes. Materials and methods. The study was conducted as a cohort prospective study with a detailed examination of 128 patients with AH (stage I–II, degree 1–2) and overweight or obesity (degree 1–2) and 21 healthy patients in the comparison group (CG). All study participants underwent a complex of clinical, laboratory and instrumental examinations, were given personalized recommendations for maintaining or correcting lifestyle; patients with AH were assessed for readiness for lifestyle changes on a 5-point scale, and were prescribed dietary changes (hypocaloric version of the DASH diet – Dietary Approaches to Stop Hypertension), optimal level of physical activity and AH medications were adjusted as needed. Subgroup 1 of patients with AH and obesity who demonstrated a high level of readiness for changes included 64 patients who were additionally prescribed omega-3 polyunsaturated fatty acids at a dose of 1007 mg (including: eicosapentaenoic acid – 33%, docosahexaenoic acid – 22%), coenzyme Q10 – 10 mg, vitamin E – 3 mg once a day during meal. Subgroup 2 included 64 patients with AH and obesity and low readiness for changes, who were compared by age and gender with patients in subgroup 1. The effectiveness of the proposed interventions was assessed after 10 months using the statistical method of image classification. The minimum distance criterion – Mahalanobis distance was used to calculate the results of treatment. The feasibility of the chosen method is justified by the large number of studied indicators in dynamics, the clarity and comprehensibility of the obtained evaluation data and the possibility of computerised statistical processing. Results. For analysis, 31 indicators were obtained from each patient in the dynamics of treatment and observation. The Mahalanobis distance was determined upon inclusion in the study: between subgroup 2 and the CG – 45.94 (significant differences), between subgroup 1 and the CG – 45.87 (significant differences), between subgroup 1 and subgroup 2 – 1.59 (homogeneous, comparable); at the end of the study: between subgroup 1 and the CG the distance was 28.999 (statistically insignificant difference), between subgroup 2 and the CG – 59.412 (statistically significant difference), between subgroup 1 and subgroup 2 – 3.093 (the distance has increased, but does not reach statistical significance). Conclusions. 1. The use of a holistic personalized approach in the management of patients with AH and obesity in primary care, which is based on the assessment of a person’s individual readiness for lifestyle changes, allows to improve the results of the treatment of both AH and obesity. 2. The use of the statistical method of minimum Mahalanobis distance for processing medical research data allows to evaluate data in dynamics automatically, to prove the direction of changes in the studied parameters and obtain a visual illustrative result of the assessment.