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CUMPLIMIENTO DEL OBJETIVO TERAPEUTICO EN LA HIPERTENSION MEDIANTE LA SUPERACION DE LA INERCIA Y LA FALTA DE ADHESION AL TRATAMIENTO

(especial para SIIC © Derechos reservados)
El insuficiente conocimiento de las normativas es un impedimento médico para lograr un control adecuado de la presión arterial en la práctica clínica. En combinación con la baja tasa de adhesión al tratamiento, este hecho se asocia con un incremento de los riesgos médicos y económicos de la enfermedad. El abordaje de la inercia terapéutica y la falta de adhesión al tratamiento mediante distintas estrategias podría optimizar esta pérdida de los beneficios de la terapia.
Autor:
Paolo Ferrari
Columnista Experto de SIIC

Institución:
Fremantle Hospital


Artículos publicados por Paolo Ferrari
Recepción del artículo
25 de Abril, 2013
Aprobación
27 de Mayo, 2013
Primera edición
17 de Junio, 2013
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La hipertensión es una enfermedad frecuente y el problema tratado con más asiduidad en la práctica general. La presión arterial (PA) elevada es una causa prevalente de mortalidad y de carga de enfermedad. En general, es difícil lograr un tratamiento y tasas de control óptimos. Si bien las recomendaciones actuales señalan determinados objetivos terapéuticos, este abordaje no siempre se implementa, y el control de la PA en la práctica es mucho peor que el logrado en los estudios clínicos. La insuficiente conciencia o aplicación de las recomendaciones para hipertensión por parte de los médicos es un impedimento para lograr tasas de control de PA adecuadas en la práctica clínica. Es así que tanto el inicio de la medicación antihipertensiva como la intensificación del tratamiento dirigidos a lograr los objetivos terapéuticos en quienes se ha diagnosticado la hipertensión parecen ser brechas en la práctica (inercia terapéutica). La identificación de las barreras que evitan el uso de la evidencia es un primer paso importante para el diseño de una intervención que cierre dicha brecha. El valor práctico de cualquier tratamiento depende de una combinación de efectividad y adhesión del paciente a lo indicado. Incluso en países altamente desarrollados, sólo la mitad de los pacientes tratados por hipertensión cumplen con el tratamiento indicado. La consecuencia de las bajas tasas de adhesión a la terapia antihipertensiva es el aumento de la carga clínica y económica de la enfermedad. Apuntar a la inercia terapéutica y a la adhesión al tratamiento mediante diversas estrategias puede ayudar a disminuir las pérdidas de beneficio clínico.

Palabras clave
hipertensión, práctica clínica, adhesión, inercia terapéutica, recomendaciones


Artículo completo

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Abstract
Hypertension is a common condition and the most frequently managed problem in general practice. High blood pressure (BP) is a leading cause of mortality and disease burden. Globally, it has been difficult to attain optimal hypertension treatment and control rates. Although current practice guidelines recommend treating patients with hypertension to defined BP goals, the approach is not widely implemented, and BP control in clinical practice is much worse than that attained in clinical trials. Insufficient awareness or poor application of hypertension guidelines by physicians may be an impediment to achieving adequate BP control rates in clinical practice. Therefore, both the initiation of antihypertensive medication and the intensification of treatment to therapeutic goals in those with hypertension have been identified as evidence practice gaps (therapeutic inertia). Identifying the barriers that prevent the best use of evidence is an important first step in designing an intervention to close that evidence practice gap. The practical value of any therapy depends on a combination of effectiveness and the extent to which the patient adheres to the prescribed treatment. Even in highly developed countries only half of the patients treated for hypertension adhere to the prescribed treatment. The consequence of the low rates of adherence to BP-lowering therapy is the increasing clinical and economic burden of those conditions. Targeting therapeutic inertia and adherence to medication through a variety of strategies may help in reducing lost therapeutic benefit.

Key words
hypertension, clinical practice, adherence, therapeutic inertia, guidelines


Full text
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Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Cardiología, Medicina Interna
Relacionadas: Atención Primaria, Educación Médica, Geriatría, Medicina Familiar



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Enviar correspondencia a:
Paolo Ferrari, University of Western Australia andDepartment of Nephrology, Fremantle Hospital, WA 6160, Alma Street, Perth, Australia
Bibliografía del artículo
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