[Compliance problems in therapy resistant hypertension]

DEFINITION AND FREQUENCY: Hypertension may be termed refractory, when a therapeutic plan that has included nonpharmacologic treatment and the prescription of a triple drug combination in adequate doses including a diuretic, has failed to lower the blood pressure < 140/90 mmHg. True resistance can only be found in 2-5% of all hypertensive patients.

Pseudoresistance to antihypertensive therapy is common and often due to a suboptimal drug regime, interactions with other drugs or a secondary form of hypertension. It is estimated that in more than two thirds of patients with hypertension, poor compliance is at least part of the problem. Poor compliance is not easily detected by the physicians, and studies showed that they could not predict compliance with any more accuracy than if they were guessing. Factors for a poor compliance are lack of patient information about hypertension and its treatment, side effects of prescribed drugs, lack of teaching in the self-measurement of blood pressure and patient's dissatisfaction with the disease. Improvement of compliance can be achieved by selecting long-acting drugs or drug combinations. Structured teaching programs, as they become part of the Disease Management Programs (DMPs) in Germany can improve compliance as well.

If noncompliance can be excluded, the dosage of antihypertensive drugs should be increased to a maximum if tolerated, or combinations of four or more drugs can be used, including drugs like minoxidil.