Related Experiment Video

Updated: Jun 21, 2026

Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension
04:37

Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension

Published on: June 6, 2025

Intensifying therapy for hypertension despite suboptimal adherence

Adam J Rose1, Dan R Berlowitz, Meredith Manze

  • 1Center for Health Quality, Outcomes, and Economic Research, Boston University School of Medicine, 200 Springs Road, Bedford, MA 01730, USA. adamrose@bu.edu

Hypertension (Dallas, Tex. : 1979)
|July 8, 2009
PubMed

Insights

Intensifying treatment for high blood pressure (BP) effectively lowers systolic BP regardless of patient adherence. This study suggests treatment intensification benefits all patients, even those with poor adherence.

Area of Science:

  • Cardiovascular Medicine
  • Clinical Pharmacy
  • Hypertension Management

Background:

  • Effective blood pressure (BP) control is crucial for hypertensive patients.
  • Suboptimal patient adherence often complicates treatment intensification (TI) strategies.
  • The impact of TI on BP outcomes in relation to adherence levels requires further investigation.

Purpose of the Study:

  • To determine if the effect of treatment intensification on blood pressure varies by patient adherence.
  • To analyze the association between TI and final systolic blood pressure (SBP) across different adherence quartiles.

Main Methods:

  • Observational study of 819 hypertensive patients in primary care.
  • Treatment intensification (TI) calculated as (medication changes - elevated BP visits) / total visits.
  • Adherence measured using MEMS caps; patients grouped into adherence quartiles or 'missing' adherence.

Main Results:

  • Overall, each additional TI per 10 visits predicted a 2.0 mm Hg decrease in final SBP (P<0.001).
  • SBP reduction associated with TI was consistent across all adherence levels, ranging from 1.6 to 2.4 mm Hg.
  • No statistically significant differences in BP reduction were observed between adherence groups.

Conclusions:

  • Treatment intensification is associated with similar blood pressure improvements irrespective of patient adherence levels.
  • Further randomized trials are recommended to confirm optimal management strategies for patients with suboptimal adherence.

Related Concept Videos

Hypertension IV: Drug Therapy and Lifestyle Modifications01:28

Hypertension IV: Drug Therapy and Lifestyle Modifications

Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...
Hypertension V: Nursing Management01:23

Hypertension V: Nursing Management

The nursing management of hypertension involves accurately assessing symptoms, making a comprehensive nursing diagnosis, collaborating with patients to set goals, and implementing targeted interventions to mitigate the condition's impact and improve patient well-being.Comprehensive AssessmentThe initial step in nursing care for hypertension involves a thorough patient assessment. It includes evaluating symptoms such as headaches, dizziness, blurred vision, and previous hypertension episodes.
Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
Drug Therapy01:28

Drug Therapy

The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Hypertension III: Clinical Manifestations and Diagnostic Studies01:30

Hypertension III: Clinical Manifestations and Diagnostic Studies

Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...