Personalized approach to the prevention of arterial hypertension in patients of the older age group 65+

The study was conducted to assess the quality of life of elderly and senile patients with arterial hypertension (AH); for this purpose, the results of using the European Quality of Life Questionnaire (EQ-5D-3L) and the Hospital Anxiety and Depression Scale (HADS) for these patients were studied.  It was found that, compared with patients without hypertension, patients with hypertension have more difficulties in daily life and higher levels of anxiety and depression.  At the outpatient stage of management of patients in the older age group with hypertension, conduct a survey using EQ-5D-3L and HADS and, after evaluating its results, add measures to the rehabilitation program to correct the physical and mental components of quality of life, which will further avoid complications of hypertension and increase the life expectancy of patients with this disease.

BACKGROUND.  In our country, the aging of the population is characterized by an increase in the number of residents over the age of able-bodied and an increase in life expectancy. It is noted that about 80 % of the older generation suffer from polymorbid chronic pathology. Most often, 1 patient over the age of 60 has more than 4 chronic diseases and the need for medical care increases.

Hypertension is one of the most common diseases of the cardiovascular system with complications that cause disability and premature mortality, especially in the older age group of patients. Hypertension not only has high risks of complications, but also leads to a decrease in the quality of life of patients, worsening their psychological and physical condition. Specific questionnaires can be used to assess one specific category of quality of life (physical or mental condition). or to assess the quality of life for a certain disease. Based on the results of the survey of patients with hypertension, it is possible to introduce measures to correct the psychological and physical components of quality of life into the programs of preventive measures during dispensary supervision.

OBJECTIVE. To evaluate the quality of life of elderly and senile patients with hypertension based on the results of surveys using the EQ-5D-3L and HADS questionnaires.

MATERIALS AND METHODS. The object of the study was 120 patients over 65 years old with hypertension who signed an informed consent to data processing in the framework of a scientific study (the main group), and 40 patients of the same age group who did not suffer from hypertension (the control group). All study participants underwent physical and laboratory examinations. Additionally, all patients were surveyed using the EQ-5D-3L and HADS questionnaires.

RESULTS. As a result of the study, it was revealed that 65+ patients suffering from hypertension are more likely to be overweight or obese compared to the control group.

The use of questionnaires in the study allowed us to establish the following facts.

Patients with hypertension are more likely than the control group to experience difficulties in daily life and increased levels of anxiety and depression.

Thus, 26.6 % of AH sufferers have 8–10 points on the anxiety scale (0 % in the control group); more than 10 points ― 7.6 % (0 % in the control group). The fact of a more frequent occurrence of depression in patients with hypertension has been recorded: 16.5 % have 8–10 points (0 % in the control group).

This suggests that these patients need a correction of their psychoemotional state.

In addition, it was found statistically significantly (p < 0.05) that patients with combined pathology (CHD + AH or DM + AH) are more likely to have difficulty walking. This is significantly related to the presence of pain or discomfort during movement. Thus, it is confirmed that patients with polymorbid pathology have a reduced quality of life component. A survey of patients with hypertension showed that with a significant degree of probability (p < 0.001), walking difficulties are closely correlated with age.

The data from the results of the study in the group of older women suffering from hypertension showed that in the female cohort of such patients, as well as in the general group, a significant (p < 0.05) relationship was established between the severity of abdominal obesity (waist circumference > 88 cm) and the risk of cardiovascular diseases.

CONCLUSION. Based on the results of the study, it is recommended to conduct an EQ-5D-3L and HADS questionnaire at the outpatient stage of patient management and, after evaluating the results, add measures to correct the physical and mental components of quality of life to rehabilitation programs.

With the information obtained as a result of the patient survey, it is possible to correct the diet, daily routine, patient behavior, as well as pharmacorrection and, as a result, optimize the quality of life, which will further avoid complications of hypertension and increase the life expectancy of patients with this disease.