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True Resistant Hypertension Following Observed Drug Ingestion: A Systematic Evaluation
Jill Bunker1, Choon-Lan Chang2, Neil Chapman1
1Imperial College Healthcare NHS Trust, International Centre for Circulatory Health, Hammersmith Hospital, London, UK.
Journal of Clinical Hypertension (Greenwich, Conn.)
|August 21, 2016
Summary
Many patients with suspected resistant hypertension achieve blood pressure control after observed drug ingestion. A minority (35%) truly have treatment-resistant hypertension, highlighting the importance of adherence in hypertension management.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Treatment-resistant hypertension (TRH) poses a significant clinical challenge.
- Poor medication adherence is a suspected contributor to TRH.
- Accurate assessment of adherence is crucial for diagnosing true TRH.
Purpose of the Study:
- To investigate the impact of observed drug ingestion on blood pressure (BP) control in patients with suspected TRH.
- To differentiate between non-adherence and true treatment resistance in hypertension management.
Main Methods:
- Prospective study involving 102 patients with suspected TRH.
- Observed drug ingestion followed by BP monitoring (clinic and 24-hour ambulatory BP monitoring [ABPM]).
- BP measurements taken before, during, and after observed drug ingestion, and at follow-up.
Main Results:
- Median BP decreased significantly after observed drug ingestion (170/91 mm Hg at referral to 142/79 mm Hg post-ingestion).
- 56% of patients achieved BP goals (<140/90 mm Hg clinic or <135/85 mm Hg ABPM) during the study.
- True treatment-resistant hypertension was confirmed in 35% of patients after adherence was verified.
Conclusions:
- Observed drug ingestion effectively identifies patients with suboptimal adherence contributing to apparent TRH.
- A significant proportion of patients initially suspected of TRH are actually controlled with verified adherence.
- This approach aids in distinguishing true TRH from adherence-related hypertension, guiding appropriate therapeutic strategies.
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