RU2371082C1 - Method for estimating clinical effectiveness in patients with arterial hypertension and obesity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely cardiology and can be used, particularly to estimate clinical effectiveness for arterial hypertension combined with obesity. An integrated assessment of psychological, social and physical activity is applied herewith considering morbidity by means of the questionnaires SF-36 and "Clinical and Therapeutic Aspect of Life Quality" in patients suffering from arterial hypertension combined with obesity before treatment. A dynamic coefficient is calculated from the questionnaire "Clinical and Therapeutic Aspect of Life Quality" by subtraction the score obtained with underlying drug therapy from that in the beginning of treatment. If hypotensive therapy and low-calorie diet only are applied, the ratio of points from SF-36 100 to 500 and 30 to 10 points from the questionnaire "Clinical and Therapeutic Aspect of Life Quality" in correlation with the dynamic coefficient 0 to 9, indicates clinical ineffectiveness of hypotensive therapy only without drug correction of overweight and poor life quality. In case of the combined hypotensive therapy and drug correction of obesity, the ratio of points from SF-36 500 to 800 and of points from "Clinical and Therapeutic Aspect of Life Quality" 10 to 0 in correlation with the dynamic coefficient 10 and more, clinical effectiveness is registered with high life quality of patients with arterial hypertension.

EFFECT: method allows improving clinical efficiency of estimate of hypotensive therapy combined with weight reduction techniques, considering activities, emotional, psychological and social status of the patient.

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Description

The invention relates to medicine, namely cardiology, and can be used, in particular, to assess the effectiveness of the treatment of arterial hypertension in combination with obesity.

In clinical medicine, currently no methods are known for assessing the effectiveness of antihypertensive therapy in combination with weight loss methods using questionnaires on quality of life. However, there are various ways to assess the quality of life in patients with arterial hypertension. Using a questionnaire created by the author, a study was made of indicators of quality of life in patients with various body mass indices [Abramovich S.G. // Quality of life indicators and body mass index in elderly patients with hypertension. - Ter. archive. - 2004. - No. 6. - S.27-29].

However, this method has disadvantages:

- the fundamental criteria for the quality of life are not fully reflected;

- There is no clinical evidence that weight loss improves quality of life.

There is data in the literature on assessing the quality of life according to the methodology of V.P. Zaitsev, with the help of which the influence of antihypertensive drugs on the quality of life of patients was determined [Kolpakova E.V. / The effect of moexipril, acebutolol and valsartan therapy on the daily blood pressure profile and quality of life of patients with hypertension. - Moscow, 1999].

The disadvantages of the method are:

- quality of life is assessed only by a questionnaire that assesses the quality of life of patients against a background of lowering blood pressure without taking into account excess body weight;

- the boundaries, high and low intervals by which it is possible to objectively judge the quality of life of the patient are not defined.

The closest way to the proposed one is to study the quality of life of patients with arterial hypertension using the SF-36 questionnaire and change the quality of life indicators against the background of antihypertensive therapy [Parakhonsky AP // Assessment of the quality of life of patients with arterial hypertension. - Basic research. - 2006. - No. 12. - S.33-34].

The disadvantages of the above method are:

- quality of life assessment is carried out only by a general questionnaire, which does not reflect the specificity of the disease against the background of obesity;

- do not take into account the effect of excess body weight on the quality of life;

- there are no clear intervals at which it is possible to objectively, taking into account clinical and medical history data, a decrease or increase in the quality of life.

The aim of the presented invention is to increase the effectiveness of the evaluation of antihypertensive therapy in combination with methods to reduce weight.

The goal of the invention is achieved by using a comprehensive assessment of the psychological, social and physical functioning of patients with arterial hypertension in combination with obesity before and after treatment, taking into account the clinical manifestations of the disease using questionnaires SF-36 and "Clinical and therapeutic aspect of quality of life ”, Containing the following questions: 1. Do you note that your blood pressure has increased more often? 2. Do you think your blood pressure numbers have become higher? 3. Does your headache bother you? 4. Do you feel dizzy? 5. Are you worried about a heartbeat? 6. Do you have tinnitus? 7. Do you think you are overweight? 8. Do you notice a decrease in memory? 9. Recently, have you noticed weight loss? 10. Do you suffer from insomnia? 11. Are you nauseous? 12. Does your mouth dry? 13. Have you been bothered by drowsiness lately? 14. Do you notice a decrease in the amount of food consumed? 15. Do you have increased appetite? 16. Recently, you began to note a lowered mood, that you have become irritable? 17. Do constipations bother you ?, while the answers are rated in points: “no” - 0 points, “slightly” - 1 point, “strong” - 2 points, “very strong” - 3 points, but the exception is 9 and 14 questions that are evaluated: “no” - 3 points, “insignificantly” - 2 points, “strong” - 1 point, “very strong” - 0 points, calculate the dynamic coefficient by subtracting the Clinical and therapeutic aspect of quality of life questionnaire from the total score at the beginning of treatment, the total score obtained in the context of drug therapy; when conducting only antihypertensive therapy and a low-calorie diet, the ratio of the number of points for SF-36 from 100 to 5 00 and from 30 to 10 points according to the questionnaire “Clinical and therapeutic aspect of quality of life” in correlation with a dynamic coefficient from 0 to 9 indicates the ineffectiveness of only hypotensive therapy without drug correction of overweight and low quality of life, when combined with antihypertensive therapy and drug correction of obesity, the ratio of the number of points for SF-36 from 500 to 800 and the number of points in the “Clinical and therapeutic aspect of the quality of life” from 10 to 0, in correlation with a dynamic coefficient of 10 and higher, the effectiveness of treatment and a high assessment of the quality of life of patients with arterial hypertension are noted.

The treatment of arterial hypertension in patients with obesity requires improvement, due to the fact that adipose tissue is an endocrine organ that synthesizes a number of active substances involved in the pathogenesis of hypertension. A change in metabolic processes in obesity leads to activation of the renin-angiotensin-aldosterone system, an increase in the activity of the sympathetic nervous system, and an increase in total peripheral vascular resistance [Obesity. / Ed. I. I. Dedov, G. A. Melnichenko, 2004. - P. 21-36].

Therefore, patients need correction of overweight. For this purpose, a hypocaloric diet with a moderate increase in physical activity is prescribed. Some patients with a BMI> 30 kg / m ² were treated with antihypertensive drugs in combination with meridia (sibutramine). The choice of sibutramine is due to its double effect on the energy balance: it reduces the need for food and enhances energy consumption.

In the literature, there is an indication of the medical treatment of obesity with the help of the drug meridia (sibutramine), which leads to an improvement in metabolic parameters and a decrease in blood pressure [S. Butrova. // Sibutramine in the treatment of obesity. - Russian medical journal. - 2001. - No. 9. - S.348-; Mkrtumyan A.M. // Effective treatment of obesity by affecting reduced food intake and increased energy expenditure. - Obesity and metabolism. - 2007. - No. 1. - S.15-18]. However, the author did not determine the level of scores for reducing or improving the quality of life in patients with arterial hypertension.

In order to increase the effectiveness of evaluating antihypertensive therapy in combination with weight loss methods, we propose a method for combining the SF-36 questionnaire and the created “Clinical and therapeutic aspect of quality of life” questionnaire, in which objective symptoms reflecting the specificity of the disease in terms of quality of life are introduced.

The SF-36 questionnaire reflects all aspects of patients' lives - physical, mental and social. It consists of 36 questions, the results of which are evaluated on 8 scales in points (from 0 to 100). The higher the result, the better the quality of life. The maximum number of points is 800.

Scales of the SF-36 questionnaire (Table 1):

General Health (GH) - General Health Scale;

Physical Functioning (PF) - physical functioning;

Role-Physical (RP) - a scale of role-based physical functioning;

Role-Emotional (RE) - role-playing emotional functioning;

Social Functioning (SF) - social functioning;

Bodily Pain (BP) - pain scale;

Vitality - vitality scale;

Mental Health (MH) - Mental Health Self-Assessment.

The questionnaire “Clinical and therapeutic aspect of quality of life” includes the following questions, which reflect the most frequent complaints of patients and side effects of therapy:

1. Do you notice that your blood pressure has increased more often?

2. Do you think your blood pressure numbers have become higher?

3. Does your headache bother you?

4. Do you feel dizzy?

5. Are you worried about a heartbeat?

6. Do you have tinnitus?

7. Do you think you are overweight?

8. Do you notice a decrease in memory?

9. Recently, have you noticed weight loss?

10. Do you suffer from insomnia?

11. Are you nauseous?

12. Does your mouth dry?

13. Have you been bothered by drowsiness lately?

14. Do you notice a decrease in the amount of food consumed?

15. Do you have increased appetite?

16. Recently, you began to note a lowered mood, that you have become irritable?

17. Do constipation bother you?

Answers to questions are evaluated in points: “no” - 0 points, “insignificantly” - 1 point, “strong” - 2 points, “very strong” - 3 points. The exceptions are 9 and 14 questions, which are rated: “no” - 3 points, “slightly” - 2 points, “strong” - 1 point, “very strong” - 0 points. The maximum amount of points obtained as a result of clinical studies on the questionnaire "Clinical and therapeutic aspect of quality of life" is 30 points.

For a more accurate assessment and demonstration of the effectiveness of therapy using the questionnaire "Clinical and therapeutic aspect of the quality of life" is a dynamic coefficient (K), which is calculated by subtracting the total score of the second dynamic questionnaire (A ₂ ) on the background of drug therapy from the amount of the first study at the beginning of treatment (A ₁ ): A ₁ -A ₂ = K. A result from 0 to 9 points indicates the ineffectiveness of treatment and the need for correction of therapy. A score of 10 or more confirms the effectiveness of the treatment.

Thus, summing up the final results of the questionnaire, we draw conclusions about the effectiveness or non-effectiveness of antihypertensive therapy in combination with methods to reduce weight. The combination of two questionnaires allows you to fully evaluate the physical, mental and social functioning, taking into account the characteristics of the disease. At present, quality of life is becoming an independent criterion for evaluating the effectiveness of treatment, allowing an individual approach to patients when choosing a treatment.

The proposed method of the invention was tested on 30 patients with essential arterial hypertension of the I-III degree and obesity of the I-III degree on the basis of the therapeutic, cardiological department of the NIH MSC and the cardiology department of the Clinical Hospital No. 3 of Astrakhan during 2007-2008.

Below are the results of testing.

Example 1. Patient T., 51 year old, case history No. 4971-08, was admitted 16.06.08 with complaints of headache, dizziness, severe weakness. The patient considers himself for 15 years, when blood pressure began to rise, bother headaches, dizziness, palpitations.

General condition is satisfactory, clear consciousness. Patient with proper physique, excessive subcutaneous fat development. Height - 160 cm, weight - 105 kg, BMI (body mass index) = 41 kg / m ² . The skin is clean, pale pink in color. Peripheral lymph nodes are not enlarged. Percussion over the lungs pulmonary sound. Auscultatory vesicular breathing in the lungs, no wheezing. Respiratory rate 18 in 1 minute. The boundaries of relative cardiac dullness are shifted to the left by 1.5 cm. Heart sounds are muffled, the rhythm is correct. Heart rate 86 beats per 1 minute, blood pressure - 180/100 mm Hg The abdomen on palpation is soft, painless. Liver on the edge of the right costal arch. No peripheral edema.

Diagnosed with Hypertension II degree, II stage. Risk III. Obesity III degree.

The result of the first questionnaire survey (see table):

- SF-36 - 230 points (GH - 20, PF - 60, RF - 0, RE - 0, SF - 38, BP - 41, VT - 35, MH - 36);

- “Clinical and therapeutic aspect of the quality of life” amounted to 21 points.

Prescribed treatment: hypocaloric diet, ACE inhibitors (enalapril 20 mg / day), β-blockers (egilok 50 mg / day), diuretics (indapamide 2.5 mg / day), antiplatelet agents (cardiomagnyl 75 mg / day).

After 3 months, a second survey was conducted with a questionnaire.

The patient complains of headaches, weakness. The physique is correct, the development of subcutaneous fat is excessive. Height - 160 cm, weight - 105 kg, BMI = 41 kg / m ² . The skin is pale pink, clean. Auscultatory vesicular breathing in the lungs, no wheezing. The boundaries of relative cardiac dullness are shifted to the left by 1.5 cm. Heart sounds are muffled, rhythmic. Heart rate of 70 beats per 1 minute, blood pressure - 155/95 mm Hg The abdomen is painless on palpation.

When re-questioning, the following results were obtained from the questionnaires (see table):

- SF-36 - 255 points (GH - 35, PF - 60, RF - 0, RE - 0, SF - 50, BP - 32, VT - 30, MH - 48);

- “Clinical and therapeutic aspect of the quality of life” - 21 points;

- dynamic coefficient - 0 points.

Given the point-by-point assessment of the two questionnaires, it can be concluded that the treatment is poor.

Analyzing the data obtained on SF-36, we see that against the background of the treatment, indicators on the scales of general health, social functioning, and self-esteem of mental health improve slightly. But there is a decrease in vitality and an increase in pain intensity.

Example 2. Patient I., 53 years old, was received on 28.01.08 No. of case history 835-08. Complains of high blood pressure, headache, dizziness, tinnitus, pain in the heart. From the anamnesis of the disease: hypertension for 15 years. Takes ACE inhibitors (enalapril 10 mg / day) and β-blockers (atenolol 50 mg / day). Deterioration in a few days.

General condition is satisfactory, clear consciousness. Patient with proper physique, excessive subcutaneous fat development. Height - 168 cm, weight - 112 kg, BMI = 39.7 kg / m ² . The skin is pale pink, clean. Peripheral lymph nodes are not enlarged. Percussion over the lungs pulmonary sound. Auscultatory vesicular breathing in the lungs, no wheezing. Respiratory rate 18 in 1 minute. The boundaries of relative cardiac dullness are shifted to the left by 1.5 cm. Heart sounds are muffled, rhythmic. Heart rate 70 beats per 1 minute. HELL - 190/100 mm Hg The abdomen is painless on palpation. Liver on the edge of the right costal arch. No peripheral edema.

Diagnosed with hypertension of the III degree, stage III. Risk IV. Obesity II degree.

The results of the first questionnaires without therapy (table 1):

- SF-36 - 366 points (GH - 82, PF - 60, RF - 25, RE - 0, SF - 75, BP - 52, VT - 20, MH - 52).

- “Clinical and therapeutic aspect of the quality of life” - 17 points.

Treatment: hypocaloric diet, ACE inhibitors (quadropril 6.21 mg / day), β-blockers and diuretics (tenoric 50 mg / day), disaggregants (cardiomagnyl 75 mg / day).

Re-examination and questionnaire after 3 months.

The patient complains of headache, tinnitus, severe weakness. General condition is satisfactory. Height - 168 cm, weight - 110 kg, BMI = 39 kg / m ² . Auscultatory vesicular breathing in the lungs, no wheezing. NPV - 18 in 1 minute. Heart sounds are muffled, rhythmic. Heart rate - 71 beats per 1 minute. HELL - 145/90 mm Hg The abdomen is painless on palpation.

Repeated questionnaire survey after 3 months of drug therapy (Table 1):

- SF-36 - 413 points (GH - 82, PF - 70, RF - 25, RE - 34, SF - 63, BP - 62, VT - 25, MH - 52);

- “Clinical and therapeutic aspect of the quality of life” - 12 points.

- Dynamic coefficient - 5 points.

The findings show a slight improvement in physical functioning, role-playing emotional functioning, and a decrease in pain intensity. And on a scale of social functioning, the number of points is less. Thus, in the above clinical example, the need for correction of the treatment is demonstrated.

Example 3. Patient E., 68 years old, No. 26254/1701, was admitted 10/19/07 with complaints of dizziness, intense headaches, palpitations, tinnitus. The patient considers himself for 30 years, when high blood pressure figures began to be recorded.

General condition is satisfactory, clear consciousness. Patient with proper physique, excessive subcutaneous fat development. Height - 164 cm, weight - 92 kg, BMI = 34.2 kg / m ² . The skin and visible mucous membranes are pale pink in color, clean. Peripheral lymph nodes are not enlarged. Percussion over the lungs pulmonary sound. Auscultatory vesicular breathing in the lungs, no wheezing. Respiratory rate 20 in 1 minute. The boundaries of relative cardiac dullness are shifted to the left by 2 cm. Heart sounds are muffled, rhythmic, emphasis II tone on the aorta. Heart rate of 87 beats per 1 minute, blood pressure - 210/110 mm Hg The abdomen is painless on palpation. The liver is 1 cm below the costal arch. No peripheral edema.

Diagnosed with hypertension of the III degree, stage III. Risk IV. Obesity II degree.

The result of the first study on questionnaires (Table 1):

- SF-36 - 109: GH - 10, PF - 20, RF - 0, RE - 0, SF - 50, BP - 12, VT - 5, MH - 12.

- “Clinical and therapeutic aspect of the quality of life” - 30 points.

Prescribed treatment: hypocaloric diet, ACE inhibitors (enalapril 20 mg / day), β-blockers (egilok 100 mg / day), diuretics (indapamide 2.5 mg / day), antiplatelet agents (cardiomagnyl 75 mg / day).

After 3 months, a second survey was conducted with a questionnaire. The patient complains of headaches, tinnitus, weakness. The physique is correct, the development of subcutaneous fat is excessive. Height - 164 cm, weight - 94 kg, BMI = 34.9 kg / m ² . The skin is pale pink, clean. Auscultatory vesicular breathing in the lungs, no wheezing. The boundaries of relative cardiac dullness are shifted to the left by 2 cm. Heart sounds are muffled, rhythmic, emphasis II tone on the aorta. Heart rate 73 beats per 1 minute, blood pressure - 155/100 mm Hg The abdomen is painless on palpation.

When re-studying the questionnaires, the following results were obtained (see table):

- SF-36 - 237 points (GH - 15, PF - 30, RF - 0, RE - 67, SF - 50, BP - 31, VT - 20, MH - 24);

- “Clinical and therapeutic aspect of the quality of life”, the result was 22 points;

- Dynamic coefficient - 8 points.

Against the background of the treatment, the questionnaire shows a slight improvement in physical functioning, role-playing emotional functioning, vitality, mental health, a decrease in pain intensity, but remain at a very low level. Thus, in the above clinical example, the need for correction of the treatment is demonstrated.

Example 4. Patient G., 50 years old, medical history No. 8512-07, was received on October 24, 2007 with complaints of headache, pain in the heart, dizziness, severe weakness.

The patient considers himself since 2001, when blood pressure began to rise. It was treated on an outpatient basis, takes ednit, atenolol. Deterioration within 1 month. General condition unsatisfactory, clear consciousness. Patient with proper physique, excessive subcutaneous fat development. Height - 160 cm, weight - 90 kg, BMI = 35.2 kg / m ² . The skin and visible mucous membranes are pale pink in color, clean. Peripheral lymph nodes are not enlarged. Percussion over the lungs pulmonary sound. Auscultatory vesicular breathing in the lungs, no wheezing. Respiratory rate 19 in 1 minute. The boundaries of relative cardiac dullness are shifted to the left by 1 cm. Heart sounds are muffled, rhythmic. Heart rate 80 beats per 1 minute. HELL - 170/100 mm Hg The abdomen is painless on palpation. Liver on the edge of the right costal arch. No peripheral edema.

Diagnosed with Hypertension II degree, III stage. Risk III. Obesity II degree.

Before treatment, the results of the questionnaires were (see table):

- SF-36 - 241 points (GH - 40, PF - 40, RF - 0, RE - 0, SF - 50, BP - 21, VT - 30, MH - 60);

- “Clinical and therapeutic aspect of the quality of life” - 25 points.

Treatment: hypocaloric diet, ACE inhibitors (enalapril 15 mg / day), β-blockers (egiloc 100 mg / day), disaggregants (cardiomagnyl 75 mg / day).

After 3 months, a re-examination and questionnaire were conducted. The patient complains of heaviness in the head, dizziness. General condition is satisfactory. Height - 160 cm, weight - 88 kg, BMI = 34.4 kg / m ² . Auscultatory vesicular breathing in the lungs, no wheezing. NPV - 18 in 1 minute. Heart sounds are muffled, rhythmic. Heart rate - 69 beats per 1 minute. HELL - 145/90 mm Hg The abdomen is painless on palpation.

In dynamics after 3 months against the background of drug therapy, questionnaires using questionnaires (see table):

- SF-36 - 324 points (GH - 45, PF - 55, RF - 0, RE - 34, SF - 38, BP - 52, VT - 40, MH - 60);

- “Clinical and therapeutic aspect of the quality of life” - 18 points;

- Dynamic coefficient - 7 points.

Improving the quality of life is observed on the scales of physical functioning, pain, role-playing emotional functioning and vitality, but still remains low. Thus, the obtained data show the need for treatment correction in this patient.

Example 5. Patient O., 45 years old, was examined 2.10.07. Complains of headache, increased blood pressure. He considers himself sick for 1 year, when headaches began to bother. I did not seek medical help. General condition is satisfactory, clear consciousness. A patient with a good physique, excessive subcutaneous fat development. Height - 180 cm, weight - 140 kg, BMI = 43.2 kg / m ² . The skin is pale pink, clean. Peripheral lymph nodes are not enlarged. Percussion over the lungs pulmonary sound. Auscultatory vesicular breathing in the lungs, no wheezing. Respiratory rate 18 in 1 minute. The left border of relative cardiac dullness along the midclavicular line. Heart sounds are muffled, rhythmic. Heart rate 74 beats per 1 minute. HELL - 150/90 mm Hg The abdomen is painless on palpation. Liver on the edge of the right costal arch. No peripheral edema.

Diagnosed with Hypertension II degree, II stage. Risk II. Obesity III degree.

The results of the first survey without treatment according to the questionnaires were (see table):

- SF-36 - 440 points (GH - 30, PF - 70, RF - 75, RE - 100, SF - 38, BP - 52, VT - 55, MH - 20);

- “Clinical and therapeutic aspect of the quality of life” - 15 points.

Treatment: hypocaloric diet, ACE inhibitors (diroton 5 mg / day), diuretics (indapamide 2.5 mg / day), disaggregants (cardiomagnyl 75 mg / day), meridia 10 mg / day.

Re-examination and questionnaire after 3 months. There are no complaints at the time of the inspection. General condition is satisfactory. Height - 180 cm, weight - 125 kg, BMI = 38.6 kg / m ² . Auscultatory vesicular breathing in the lungs, no wheezing. NPV - 19 in 1 minute. Heart sounds are muffled, rhythmic. Heart rate - 72 beats per 1 minute. HELL - 125/80 mm Hg The abdomen is painless on palpation.

Repeated questioning on the background of drug therapy according to questionnaires amounted to (see table):

- SF-36 - 672 points (GH - 72, PF - 80, RF - 100, RE - 100, SF - 50, BP - 100, VT - 90, MH - 80);

- “Clinical and therapeutic aspect of the quality of life” - 4 points.

- Dynamic coefficient - 11 points.

Thus, in the given clinical example, we see, against the background of treatment, an improvement in physical capabilities, emotional and mental well-being, and social activity. Therefore, we can conclude that in patients with arterial hypertension and obesity, an increase in the effectiveness of antihypertensive therapy occurs only against the background of correction of excess body weight.

Example 6. Patient A., 39 years old, was admitted 04/15/07, with complaints of headaches, dizziness, palpitations. He considers himself sick since 2004, when he began to periodically be disturbed by headaches, palpitations, accompanied by an increase in blood pressure to 170/100 mm Hg. Since February 2007, it has been deteriorating, blood pressure figures have become higher, headaches and palpitations are constantly worrying. General condition is satisfactory, clear consciousness. A patient with a good physique, excessive subcutaneous fat development. Height - 180 cm, weight - 138 kg. BMI = 42.5 kg / m ² . The skin and visible mucous membranes are pale pink in color, clean. Peripheral lymph nodes are not enlarged. Percussion over the lungs pulmonary sound. Auscultatory vesicular breathing in the lungs is carried out in all departments, no wheezing. Respiratory rate 19 in 1 minute. The left border of relative cardiac dullness along the midclavicular line. Heart sounds are muffled, the rhythm is correct, there is no noise. Heart rate 80 beats per 1 minute. HELL - 160/100 mm Hg The abdomen is painless on palpation. Liver at the edge of the right costal arch. No peripheral edema. The spleen is not enlarged.

Diagnosed with hypertension of the II degree. III stage. Risk IV. Obesity III degree.

The results of the first questionnaire survey were (see table):

- SF-36 - 285 points (GH - 25, PF - 60, RP - 0, RE - 34, SF - 50, BP - 41, VT - 35, MH - 40).

- “Clinical and therapeutic aspect of the quality of life” - 20 points.

Prescribed treatment: hypocaloric diet, ACE inhibitors (diroton 20 mg / day), β-blockers (egilok 25 mg / day), disaggregants (cardiomagnyl 75 mg / day), meridia 10 mg / day.

After 3 months, a second examination of the patient. There are no complaints at the time of the inspection. General condition is satisfactory, clear consciousness. Height - 180 cm, weight - 115 kg. BMI = 35.5 kg / m ² . The skin and visible mucous membranes are pale pink in color, clean. Auscultatory vesicular breathing in the lungs, no wheezing. Respiratory rate 18 in 1 minute. Heart sounds are muffled, rhythmic, no noise. Heart rate 80 beats per 1 minute. HELL - 125/80 mm Hg The abdomen is painless on palpation. Liver at the edge of the right costal arch.

When re-questioning patients after 3 months on the background of taking drug therapy according to questionnaires, the following results were obtained (see table):

- SF-36 - 602 points (GH - 92, PF - 85, RP - 50, RE - 67, SF - 50, BP - 84, VT - 90, MH - 84).

- “Clinical and therapeutic aspect of the quality of life”, the result was 3 points;

- Dynamic coefficient - 17 points.

We see that the quality of life has improved almost twice on all scales.

The above clinical example No. 6 shows the effectiveness of antihypertensive drugs in combination with Meridia. Reducing body weight not only allows you to lower blood pressure figures, but also significantly improve the quality of life of patients.

The presented clinical examples demonstrate the importance of the study of quality of life in patients with arterial hypertension against the background of obesity. Studies and complex survey data showed that the treatment of arterial hypertension without correction of body weight does not always lead to an improvement in quality of life.

The proposed method of the invention to assess the effectiveness of the treatment of patients with arterial hypertension and obesity achieved positive effects:

1. High information content of the method of the present invention is associated with the possibility of a comprehensive assessment of changes in physical, psychological and social conditions against the background of the treatment. It was achieved by combining the general SF-36 questionnaire and the Clinical and therapeutic aspect of the quality of life questionnaire, which includes the main manifestations of hypertension and obesity.

2. The therapeutic effectiveness of the method of the invention for assessing the effectiveness of treatment of patients is associated with improving the quality of treatment, improving the clinical course of the disease and preventing complications.

3. The availability of using the method of your own invention is determined by the simplicity of technical performance and the rapid receipt of the result.

4. Diagnostic effectiveness. A method for evaluating the effectiveness of treatment of patients with arterial hypertension and obesity will improve the diagnosis results of side effects of therapy.

5. The economic efficiency of the method of the present invention is determined by the appointment of adequate therapy, which allows to improve the clinical course of the disease and, therefore, to reduce the number of days of disability and patient stay in hospital.

The proposed method can be used to assess the effectiveness of the treatment of patients with arterial hypertension and obesity. Using this method will allow you to approach the choice of therapy not only taking into account clinical manifestations, but also taking into account the patient’s functional capabilities, his emotional, psychological and social status. An individual approach to patients will improve the clinical course and outcome of the disease.

Quality of life assessment using questionnaires SF-36 and “Clinical and therapeutic aspect of quality of life” Clinical examples Questionnaire No. The results of assessing the quality of life (in points) Questionnaire SF-36 “Clinical and therapeutic aspect of the quality of life” Gh Pf RP RE SF BP VT Mh Total points Total points Coefficient (K) Example No. 1 one twenty 60 0 0 38 41 35 36 230 21 0 2 35 60 0 0 fifty 32 thirty 48 255 21 Example No. 2 one 82 60 25 0 75 52 twenty 52 366 17 5 2 82 70 25 34 63 62 25 52 413 12 Example No. 3 one 10 twenty 0 0 fifty 12 5 12 109 thirty 8 2 fifteen thirty 0 67 fifty 31 twenty 24 237 22 Example No. 4 one 40 40 0 0 fifty 21 thirty 60 241 25 7 2 45 55 0 34 38 52 40 60 324 eighteen Example No. 5 one thirty 70 75 one hundred 38 52 55 twenty 440 fifteen eleven 2 72 80 one hundred one hundred fifty one hundred 90 80 672 four Example No. 6 one 25 60 0 34 fifty 41 35 40 285 twenty 17 2 92 85 fifty 67 fifty 84 90 84 602 3 Note: An increase in the SF-36 point-by-point level and its decrease in the “Clinical and therapeutic aspect of the quality of life” is estimated as an increase in the quality of life The coefficient growth reflects an improvement in the quality of life General Health (GH) - General Health Scale; Physical Functioning (PF) - physical functioning; Role-Physical (RP) - a scale of role-based physical functioning; Role-Emotional (RE) - role-playing emotional functioning; Social Functioning (SF) - social functioning; Bodily Pain (BP) - pain scale; Vitality - vitality scale; Mental Health (MH) - Mental Health Self-Assessment.

Claims (1)

A method for assessing the effectiveness of treatment of patients with arterial hypertension and obesity by studying quality of life based on questionnaires, characterized in that they use a comprehensive assessment of the psychological, social and physical functioning of patients with arterial hypertension in combination with obesity before and after treatment, taking into account the clinical manifestations of diseases with the help of questionnaires SF-36 and the “Clinical and therapeutic aspect of quality of life”, which contains the following questions: 1. Do you note that you often have increase blood pressure? 2. Do you think your blood pressure numbers have become higher? 3. Does your headache bother you? 4. Do you feel dizzy? 5. Are you worried about a heartbeat? 6. Do you have tinnitus? 7. Do you think you are overweight? 8. Do you notice a decrease in memory? 9. Recently, have you noticed weight loss? 10. Do you suffer from insomnia? 11. Are you nauseous? 12. Does your mouth dry? 13. Have you been bothered by drowsiness lately? 14. Do you notice a decrease in the amount of food consumed? 15. Do you have increased appetite? 16. Recently, you began to note a lowered mood, that you have become irritable? 17. Do constipation bother you ?, while the answers are rated in points: “no” - 0 points, “insignificant” - 1 point, “strong” - 2 points, “very strong” - 3 points, but the exception is 9 and 14 questions that evaluate: “no” - 3 points, “slightly” - 2 points, “strong” - 1 point, “very strong” - 0 points, calculate the dynamic coefficient by subtracting the “Clinical and therapeutic aspect of quality of life” questionnaire from the total score at the beginning of treatment, the total score obtained against the background of drug therapy; when conducting only antihypertensive therapy and a low-calorie diet, the ratio of the number of points for SF-36 from 100 to 500 and from 30 to 10 points according to the questionnaire “Clinical and therapeutic aspect of quality of life” in correlation with a dynamic coefficient of 0 to 9 indicates the ineffectiveness of only antihypertensive therapy without drug correction of overweight and low quality of life, when conducting combination antihypertensive therapy and drug correction of obesity, the ratio of SF-36 scores from 500 to 800 and the number of points by "Clinical and therapeutic aspects of quality of life" of 10 to 0 in correlation with dynamic coefficient of 10 or higher observed efficacy of treatment and high quality of life assessment of hypertensive patients.