Cardiologists are surprised: they are prevented from helping prevent by up to 80 percent. premature deaths

“One of the most important risk factors is the diagnosis of high blood pressure or hypertension heard by at least one in four people in Lithuania,” S. Glaveckaitė noted.

Both the European Society of Cardiology, the European Hypertension Society, and the International Hypertension Society emphasize the importance of reducing long-term increases in blood pressure to prevent complications such as strokes, heart attacks, and heart failure.

Proper drug selection is very important for hypertension control, but according to doctors, someone at the Ministry of Health is making hard-to-understand decisions that prevent patients from being prescribed the drugs that are best for them.

To achieve the goal – 3 months

Gintarė Šakalytė, a professor at the Lithuanian University of Health Sciences (LSMU) and director of the Department of Heart Failure and Defects at the Kaunas Cardiology Clinic, noted that up to one-third of the safe population suffers from high blood pressure.

“Hypertension is a disease with its complications, with organic damage, with progression and is the most threatening risk factor for CD. This is a risk factor for heart attack, stroke, it is a risk factor for sudden death and arrhythmia, ”said G. Šakalytė.

In 2018, the European guidelines for the treatment of hypertension were adopted, and Lithuanian researchers also contributed to their preparation. They established a series of important rules to follow for the treatment of high blood pressure. One of them, necessary for all, is the correction of the lifestyle.

“Because it is a disease, medications are prescribed. Most patients are prescribed combinations of drugs immediately because our task is not only to normalize blood pressure, but also to do it in a fairly short time. According to European guidelines and research programs, this must be done in 3 months, ”said the professor.

The third rule has changed

G. Šakalytė recalled that before, when talking about hypertension, doctors had a one-third rule, which they cited for about ten years. The rule was this: a third of people know they have high blood pressure, a third of them receive treatment and only a third of those who receive treatment are treated well.

“Fortunately, according to the latest scientific articles, it has changed. Now we have better numbers. They were published in last year’s serious medical journal and cited at this year’s European Congress of Cardiologists as public awareness. Already two thirds know that they have high blood pressure. Our first task would be for the third party who does not know it, that is, measure their blood pressure.

The second message is also good: of those who know they are sick, two-thirds are being treated again. This is also positive, because otherwise we do not have the means to avoid the complications of the disease.

The problem persists and a recent study reports that even in rich countries, only about 40 percent of the data comes from 12 rich countries. it achieves the target blood pressure achieved by both the physician and the patient together. If the problem is solved by the doctor alone or by the patient alone, the result will be really wrong, ”said the professor.

Fewer tablets are the best solution to the problem

Patients are treated according to the European guidelines and the national methodologies available in each country. So why don’t some patients treat high blood pressure? According to G. Šakalytė, there are many answers.

“This is usually because patients take their medication irregularly: either they forget to take it or they decide they can adjust their treatment. Drug use is really bad. As cardiologists, we see patients with severe hypertension, which is often caused by irregular medication, ”the doctor noted.

It is recommended to solve the problem in different ways: writing reminders to patients, using special medicine cabinets, involving family members. In addition, all the global guidelines state that the easiest and most effective way to improve the usability of medicines is to combine several active ingredients in a single tablet. This is called a fixed combination of drugs or polabablet.

“Almost double the usability. As a result, we cardiologists, as well as our fellow family doctors, neurologists, support this principle and try to treat the patient with the fewest number of tablets possible, while maintaining all the active ingredients necessary to treat hypertension.

According to the experience of countries that also analyze the results of their treatment, those countries that use a set of fixed drug combinations, that is, prescribe drugs in fixed doses and prescribe a smaller number of tablets, have better results ”, said Dr. G. Šakalytė.

Harmful night changes

However, as noted by Dr. Gediminas Urbonas, Associate Professor of Family Medicine Clinics at the LSMU Academy of Medicine, unexpected changes in the description of reimbursable medications make adequate treatment of high blood pressure difficult.

“All the guidelines currently in force in Europe are not about treatment with the cheapest drugs, but about individualized treatment, which is the most suitable drug for a particular patient.

So far, we have talked about the differences between ethical and generic drugs, we debate if they exist. I remind you that ethical and generic drugs are drugs manufactured by different companies, but their active principle is the same.

Today we are talking about changes in the inventory of compensatory drugs for the treatment of arterial hypertension, which the working group developed throughout 2019. The description was approved by a vote of the working group and presented to the Minister of Health for signature. This description was published earlier this year and was due to take effect on January 1 with the so-called nightly changes, that is, changes made by unknown personnel of the Ministry of Health (SAM), for which the minister apologized and said that the description would be postponed, taking effect at a later date. working group and with the academic community ”, recalled G. Urbonas.

As of May 17, the validation of said description has been postponed until October 1, when it must take effect. But, as the associate professor pointed out, and now it would take effect exactly the same, without changes, with the same so-called nocturnal changes, which say that a specialist or family doctor should choose not the most suitable for a particular person, but the most cheap to prescribe compensatory drugs for high blood pressure. specified on the VLK website at that time.

“Basically, we are no longer talking about generic and ethical drugs. We are talking about different drugs. Let’s take drugs that lower blood pressure but at the same time reduce heart rate, called beta-blockers. There are significant differences between these drugs: first of all, They have different durations of action, are cleared from the body differently (some more through the liver, some through the kidneys), and interactions with other medications also differ. Your doctor will simply not consider all of these aspects if you want to prescribe a new treatment for a patient with high blood pressure. To prescribe a reimbursable drug, the doctor will simply have to write the cheapest one, which is indicated on the VLK website, “said the doctor.

It is true, as Urbon pointed out, that the debate on the need to choose the cheapest drugs instead of those most suitable for patients has brought about further changes: “Last week, the ‘mandatory prescription’ was replaced by the ‘recommended prescription But together with this initiative, the SAM Chancellor distributed a document to the medical associations and the academy that had to be agreed in 3 days.

The societies also had three days to consider complementing the so-called good results of the work of the family doctor, for which financial incentives are given to medical institutions, with the treatment of arterial hypertension. In other words, an aggregate has emerged that predicts that the result of a good job as a family doctor will not be a reduction in blood pressure, nor in the patient’s quality of life, but rather the prescription of the cheapest medicine ”, he was surprised the doctor.

At the same time, Mr. Urbon questioned whether anyone had calculated how much the Compulsory Health Insurance Fund funds would save from changes that did not satisfy either patients or physicians.

Patient representative: this is humanization

Gediminas Augustaitis, a member of the Lithuanian Heart Association, which is treating hypertension, was surprised that the state, having prepared the aforementioned description, is not saving where it should be.

“I don’t think where these ideas can come from. This is a kind of humanization”, G. Augustaitis did not hide his disappointment.

Doctors agree that the inconvenience caused by the new order will cause the most inconvenience to patients. When a combined tablet is replaced by individual tablets, this affects not only the comfort of the patient but also the effectiveness of the treatment. Studies show that the greater the number of tablets, the worse their usability. For example, in 2017. In Hungary, more than 109 thousand. Patient data revealed that patients taking individual drugs were twice as likely to discontinue treatment as those taking a single tablet.

Interrupted or incomplete treatment with only a fraction of essential drugs results in more hospitalizations and increased mortality. A study published by Current Medical Research and Opinion reports that the combination drug reduces mortality by almost two times compared to individual tablets.

“It just came to our attention then. People already sometimes forget to take one tablet and now have to remember to take several. Many of them are sold in different packet amounts, they may not all be in a pharmacy, so this will raise another concern for people battling the disease. Also, the doctors’ reward for prescribing the cheapest drug comes at the expense of the patient. If the new order goes into effect when I receive a prescription, I will not be sure if the doctor is really giving me the treatment that is the best for me personally, or if he just wants to get a salary supplement and prescribe the cheapest medicine. Won’t he contradict the doctors with the patients? “asked G. Augustaitis.

The Lithuanian Hypertension Society, the Lithuanian Heart Association, the Heart Failure Association and the Association of Healthy Patients have been calling on SAM to change the flawed procedure for prescribing antihypertensive drugs since September 29. begins collecting signatures after the petition “There is no single recipe.” The collected signatures are expected to be delivered to the Ministry’s leadership in early December.