[Compliance and the chronotherapy of refractory arterial hypertension]

The compliance to pharmacological treatment is strongly compromised whether the disease is refractory to therapy. In addition to the generic reasons for the non-compliance, there are some other aspects, i.e. the heaviness and complexity of the treatment, the frustation for the inefficacy of the therapy. The physician is disarmed because of the limits in the available pharmacological possibilities. In fact, the refractory arterial hypertension is defined as "hypertensive state which is resistant at least to 3-4 antihypertensive drugs, each having a different mechanism of action". In order to define a disease to be refractory to treatment, it needs that all the available therapeutical strategies have been accomplished. Among the techniques for treating arterial hypertension, there is the chronotherapy which is based on the modulation of pharmacological doses and the administration of drugs as a function of the moment of highest necessity. A recent research of our group demonstrated the inconsistency of the refractoriness whether the conventionally classified resistant hypertensive patients were treated via the chronotherapeutic technique of administering the antihypertensive drugs two hours before the highest hypertensive value of the morning, afternoon and/or night. These patients were seen to be no more prone for the non-compliance. Therefore, it is proposed the reformulation of the definition for refractory arterial hypertension as "hypertensive state which is resistant at least to 3-4 antihypertensive drugs, each having a different mechanism of action, administered even with chronotherapeutic criteria".