The relevance of work is dictated by the fact that arterial hypertension is often associated with other diseases and every physician and senior student should be aware of the contraindications to antihypertensive therapy (AT) in the most common nosologies - aVblock 2nd and 3rd degree, WPW-syndrome, gout, COPD and pregnanc

Batisheva, G. A.

Bontsevich, R. A.

Gavrilova, A. A.

Kompaniets, O. G.

Myronenko, O. V.

Prozorova, G. G.

Vovk, Y. R.

DSpace at Belgorod State University

Sys Rev Pharm 2020; 11(6): 26  30 A multifaceted review journal in the field of pharmacy E-ISSN 0976-2779 P-ISSN 0975-8453  26                                                                            Systematic Review Pharmacy                                                  Vol 11, Issue 6, 2020 nd SeniDrugs Contraindicated for Arterial Hypertension Treatment according to the Phystarh Study Roman A. Bontsevich1*, Yana R. Vovk1, Anna A. Gavrilova1, Galina G. Prozorova2, Galina A. Batisheva2, Olga G. Kompaniets3, Olena V. Myronenko4  1Belgorod State University, 85 Pobedy St., Belgorod 308015 Russia E-mail: dr.bontsevich@gmail.com  2Voronezh State Medical University named after N.N. Burdenko, 10 Studencheskaya St., Voronezh 394036 Russia 3Kuban State Medical University, 4 Mitrofan Sedina St., Krasnodar 350063 Russia 4Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine, 9 Vernadskogo St., Dnipro 49044 Ukraine Corresponding author E-mail: bontsevich@bsu.edu.ru  Article History:               Submitted: 05.03.2020                        Revised: 17.04.2020                    Accepted: 28.05.2020 ABSTRACT Introduction: The relevance of work is dictated by the fact that arterial hypertension is often associated with other diseases and every physician and senior student should be aware of the contraindications to antihypertensive therapy (AT) in the most common nosologies – aV-block 2nd and 3rd degree, WPW-syndrome, gout, COPD and pregnancy.  Aim: To analyze physicians’ and medical undergraduates’ knowledge of main contraindications to AH treatment.  Material and Methods: During the multicenter study devoted to the assessment of physicians’ knowledge in treatment of AH (“PHYSTARH” study), 296 people from 5 Russian and Ukrainian cities  were surveyed in 2017-2018: 44,9% – 6th grade students, 55,1% – physicians. Results and Discussion. The study revealed an insufficient level of students’ and doctors’ knowledge of main contraindications to AH   treatment. Less than half of the respondents correctly identified drugs contraindicated in pregnancy, gout, aV-block 2nd and 3rd degree, WPW-syndrome and COPD. Conclusion. Despite the availability of antihypertensive treatment related clinical guidelines and sufficient number of information sources, the level of incorrect answers reaches a significant level in certain nosologies. Keywords: arterial hypertension, antihypertensive therapy, level of knowledge, doctors, pharmacoepidemiology, students Correspondence: Roman A. Bontsevich Belgorod State University, 85, Pobedy St., Belgorod, 308015, Russia E-mail: bontsevich@bsu.edu.ru DOI: 10.31838/srp.2020.6.06 @Advanced Scientific Research. All rights reserved  INTRODUCTION Arterial hypertension (AH)  is a disease that affects 37 million people every year [1, 2]. Cardiovascular, cerebrovascular and renal complications most often accompany this pathology [3, 4, 5]. It is also one of the leading causes of death in the world [6]. According to the recent epidemiological studies, about 54% of all stroke cases are associated with increased blood pressure [7, 8, 9]. The complexity of AH treatment is often associated with the presence of concomitant pathology or special conditions (pregnancy) that require individual selection of drugs and their dosage regimen [8, 9]. Therefore, the treatment of this pathology requires high-quality knowledge of senior medical students and physicians in the treatment of AH with important comorbid pathologies (aV-block 2nd and 3rd degree, WPW-syndrome, gout, COPD and pregnancy).  AIM Tof main contraindications to AH treatment in aV-block 2nd and 3rd degree, WPW-syndrome, gout, COPD and pregnancy.  MATERIAL AND METHODS Iundergraduates' knowledge in arterial hypertension in 2017-2018 among 296 people from 5 cities of Russia and Ukraine (Belgorod, Voronezh, Dnepr, Krasnodar and Maikop) - 45% of senior students, 55% of physicians. An original questionnaire was developed for this study [10-12]. This questionnaire is based on clinical guidelines of European Society of Cardiology 2013 [11]. Multiple-questions on absolute contraindications to antihypertensive drugs prescription in different groups of patients were analyzed in this survey.     Patients groups: pregnant women, COPD patients, patients with aV-block 2nd and 3rd degree, WPW syndrome patients.   List of AH-drugs: Enalapril, Verapamil, Bisoprolol, Hypothiazd and Torasemide.   Possible answers: "right answer", "1 mistake", "2 or more mistakes", "wrong answer". The question on COPD suggested only two variants of the answer: "true / false". All results were entered and analyzed using application programs Microsoft Excel, Access. Statistical data was processed by analyzing arbitrary contingency tables using  This method of knowledge evaluation was specially developed for the "PHYSTARH" project and cannot fully  Partial results of this work were reported at the 14th Congress of the European Association for Clinical Pharmacology and Therapeutics in Stockholm 2019 [13,14].   RESULTS AND DISCUSSION Calcium antagonists are absolutely contraindicated for prescription in WPW-syndrome. These drugs are able to improve the conductivity of the nerve impulse, including the additional bundle of Kent, which can cause ventricular fibrillation and atrial flutter [14, 15]. 39% of respondents Roman A. Bontsevich et al / Physicians and Senior Medical Students Knowledge of Drug Contraindicated for Arterial Hypertension according to the Phystarh Study  27                                                                            Systematic Review Pharmacy                                                  Vol 11, Issue 6, 2020 knew this (students  30.8%, physicians - 45.4%, <0.05), 23.5% answered with 1 or more mistakes (students-30.1%, physicians-17.8%, <0.05), 37.5% answered wrongly (students-39.1%, physicians-36.2%, >0.05) (Fig.1). The following AH medications were mistakenly denoted as prohibited by the respondents: "Enalapril"  7%, "Bisoprolol"  29.4%, "Hypothiazid"  10.6%, "Torasemide"  5%.   Figure 1: Distribution of answers to the question about drugs contraindicated in WPW-syndrome (%)  Pregnancy is a special condition in which some fairly effective antihypertensive drugs can cause serious harm to the fetus. But it is necessary to correct hypertension in these groups of patients [16], which means that the doctor must reliably know the allowed and prohibited list of drugs in pregnancy [11, 17  19].  Only 9% of respondents correctly identified drugs contraindicated in pregnancy, choosing Enalapril and Torasemide, 50% answered with 1 mistake, 23% with 2 or more mistakes, answered wrongly  18%. Gout is a disease associated with metabolic imbalance of uric acid. The leading cause of cardiovascular complications in patients with gout is arterial hypertension, the frequency of which reaches 47-72% [11, 20, 21]. The class of antihypertensive drugs contraindicated in gout is diuretics. 27.8% of respondents answered correctly, 39% with 1 mistake, 2.8% with 2 or more mistakes, 30.4% answered wrongly.  AV block is arrhythmia, which is accompanied by a slowdown in the conduction of a nerve impulse in the atrioventricular node [11, 22, 23]. Beta-blockers and dihydropyridine calcium channel blockers are contraindicated in aV-block 2nd and 3rd degree patients. 41.7% of respondents gave correct answers, 44% with 1 mistake, 0.3% with 2 or more mistakes, 14% answered wrongly. There are no absolute contraindications to antihypertensive therapy in patients with COPD [11, 24, 25]. About 26% of respondents (students  19.5%, physicians  31.3%, <0.05) know about it, 74% answered wrongly (students  80.5%, physicians  68.7%, <0.05) (Fig.2).  The following AH medications were mistakenly denoted as prohibited by the respondents: "Bisoprolol"  58.1%, "Enalapril"  18.7%, "Verapamil"  5.4%, "Hypothiazid"  3.3%, "Torasemid"  3%.   01020304050607080Correct answer 1 or more mistakes Wrong answerStudentsPhysicians* * # *р<0.05 #р>0.05  Roman A. Bontsevich et al / Physicians and Senior Medical Students Knowledge of Drug Contraindicated for Arterial Hypertension according to the Phystarh Study  28                                                                            Systematic Review Pharmacy                                                  Vol 11, Issue 6, 2020  Figure 2: Distribution of answers to the question about drugs contraindicated in COPD (%)  question about drugs contraindicated for AH treatment is presented below in Figure 3.   Figure 3: The levels of correct answers to the question about drugs contraindicated for AH treatment (%)  CONCLUSIONS 1. It was revealed that the problem of rational arterial hypertension treatment in pregnant women remains essential. Some specialists would prescribe potentially unsafe drugs (including ACE inhibitors). 2. It was revealed that 23.5% of the surveyed would restrict their patients from choosing the approved drugs in WPW syndrome treatment. It was also established that 37.5% of the respondents would not only limit the patient's drugs choice, but also to prescribe him the contraindicated medication. 3. A half of the respondents believe that beta-blockers (BB) is an absolute contraindication for COPD, however, BB do not increase but, on the contrary, lower exacerbations and mortality risks in chronic obstructive pulmonary disease. 0102030405060708090Correct answer Wrong answerStudentsPhysicians01020304050607080right answer1 mistake2 or more mistakeswrong answer*р<0.05 * * Roman A. Bontsevich et al / Physicians and Senior Medical Students Knowledge of Drug Contraindicated for Arterial Hypertension according to the Phystarh Study  29                                                                            Systematic Review Pharmacy                                                  Vol 11, Issue 6, 2020 4. Despite the availability of antihypertensive treatment related clinical guidelines and sufficient number of information sources, the level of incorrect answers reaches a significant level in certain nosologies. The absolute contraindications for drugs prescription in requires further continuous improvement.  Conflict of interest  The source of funding is missing  REFERENCES 1. Boytsov, S.A., Balanova, Y.A., Shalnova, S.A., 2014. Arterial hypertension among individuals of 25-64 years old: prevalence, awareness, treatment and control. By the data from ECCD. Cardiovascular Therapy and Prevention, 13(4):4-14.  2. Lim, S.S., Vos, T., Flaxman, A.D., 2012. 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Physicians and senior medical students knowledge of drug contraindicated for arterial hypertension according to the Phystarh study

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Physicians and senior medical students knowledge of drug contraindicated for arterial hypertension according to the Phystarh study

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