scholarly journals Improvement of Blood Pressure Control by Adherence Check in Patients With Apparent Treatment-Resistant Hypertension: A Case Series

2020 ◽  
Vol 13 ◽  
pp. 117954762090488
Author(s):  
Keiko Hosohata ◽  
Ayaka Inada ◽  
Saki Oyama ◽  
Takashi Doi ◽  
Iku Niinomi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Case Series ◽  
Pressure Control ◽  
Supporting Evidence ◽  
Treatment Resistant ◽  
Uncontrolled Blood Pressure ◽  
Important Challenge ◽  
Prescribed Medicines

Adherence to medications is an important challenge while treating chronic disease such as resistant hypertension, which is defined as uncontrolled blood pressure (BP) despite treatment with more than 3 antihypertensive drugs to achieve targets. It is possible that poor adherence is the most significant contributor to rates of pseudo-resistance among treated hypertensive patients. In this report, we describe 4 patients with apparent treatment-resistant hypertension, who received intervention to promote adherence by pharmacists who set the prescribed medicines in a weekly medication calendar and conducted a weekly pill count. The results showed that the intervention of pharmacists to medication adherence improved systolic BP in patients with apparent treatment-resistant hypertension; however, further controlled trials are required to strengthen supporting evidence.

scholarly journals Resistant Hypertension: A Real Entity Requiring Special Treatment?

2016 ◽  
Vol 11 (1) ◽  
pp. 8
Author(s):  
Stefano Taddei ◽  
Rosa Maria Bruno ◽  
◽  
◽  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Antihypertensive Drugs ◽  
Pressure Control ◽  
Clinical Situation ◽  
Special Treatment ◽  
Separate Clinical Entity ◽  
Real Entity ◽  
Definition Of

Resistant hypertension (RH) was defined many years ago as a clinical situation in which blood pressure remains uncontrolled despite concomitant intake of at least three antihypertensive drugs (one of them preferably being a diuretic) at full doses. This operative definition was aimed at identifying a subset of hypertensive patients requiring a more extensive clinical workup in order to achieve an adequate blood pressure control. An oversimplification of this picture led to consider RH as a separate clinical entity requiring special, expensive treatments, such as renal denervation and baroreceptor activating therapy. In this review we will discuss the utility and the shortcomings of the definition of RH and the possible consequences for treatment.

scholarly journals Controlling resistant hypertension

2018 ◽  
Vol 3 (2) ◽  
pp. 69-75 ◽  
Author(s):  
J David Spence
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Renal Hypertension ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Aldosterone Antagonists ◽  
Improve Blood Pressure Control ◽  
Blood Pressures

Resistant hypertension (failure to achieve target blood pressures with three or more antihypertensive drugs including a diuretic) is an important and preventable cause of stroke. Hypertension is highly prevalent in China (>60% of persons above age 65), and only ~6% of hypertensives in China are controlled to target levels. Most strokes occur among persons with resistant hypertension; approximately half of strokes could be prevented by blood pressure control. Reasons for uncontrolled hypertension include (1) non-compliance; (2) consumption of substances that aggravated hypertension, such as excess salt, alcohol, licorice, decongestants and oral contraceptives; (3) therapeutic inertia (failure to intensify therapy when target blood pressures are not achieved); and (4) diagnostic inertia (failure to investigate the cause of resistant hypertension). In China, an additional factor is lack of availability of appropriate antihypertensive therapy in many healthcare settings. Sodium restriction in combination with a diet similar to the Cretan Mediterranean or the DASH (Dietary Approaches to Stop Hypertension) diet can lower blood pressure in proportion to the severity of hypertension. Physiologically individualised therapy for hypertension based on phenotyping by plasma renin activity and aldosterone can markedly improve blood pressure control. Renal hypertension (high renin/high aldosterone) is best treated with angiotensin receptor antagonists; primary aldosteronism (low renin/high aldosterone) is best treated with aldosterone antagonists (spironolactone or eplerenone); and hypertension due to overactivity of the renal epithelial sodium channel (low renin/low aldosterone; Liddle phenotype) is best treated with amiloride. The latter is far more common than most physicians suppose.

scholarly journals Resistant hypertension: a review

2021 ◽  
Vol 8 (9) ◽  
pp. 1433
Author(s):  
Anant Parasher ◽  
Rajat Jhamb
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Resistant Hypertension ◽  
Alcohol Intake ◽  
Antihypertensive Drugs ◽  
Patient Adherence ◽  
Dietary Sodium ◽  
Lifestyle Modifications ◽  
Refractory Hypertension ◽  
Uncontrolled Blood Pressure

Resistant hypertension is currently defined as uncontrolled blood pressure despite the use of optimal doses of three antihypertensive medications, of which one is a diuretic. Several factors have been identified as contributors to resistant hypertension such as poor patient adherence, physician inertia, inadequate doses or inappropriate combinations of antihypertensive drugs, excess alcohol intake, certain drugs and volume overload. Uncontrolled blood pressure is a considerable cardiovascular and neurological risk factor that can lead to possible end-organ consequences of untreated hypertension, including heart failure, stroke, ischemic heart disease and renal failure. A comprehensive history and physical examination are essential for pointing towards to an underlying diagnosis. A PubMed search was conducted for review articles and papers from 1955 to 2019 containing the keywords ‘resistant hypertension’, ‘secondary hypertension’, ‘refractory hypertension’, ‘heart failure’ and ‘stroke’, and the literature was compiled. Non-pharmacological measures chiefly include lifestyle modifications such as smoking cessation, reduction in alcohol intake, dietary sodium restriction, healthy eating plans, increased physical activity and weight loss. Among recommended drugs, spironolactone and beta blockers are the preferred fourth- and fifth-line drugs respectively, in patients unresponsive to ACE Inhibitors, calcium channel blockers as well as diuretics. Although most patients are well controlled on extended drug regimes, some develop refractory hypertension which does not even respond to the five-drug regimen. Interventional therapies such as renal denervation and carotid sinus stimulation have been developed for patients with refractory hypertension, but still require further research and follow up to ascertain their full potency and efficacy.

scholarly journals Novel approaches to treat resistant hypertension

2020 ◽  
Vol 26 (1) ◽  
pp. 10-34
Author(s):  
Aleksandra Cherneva ◽  
Ivo Petrov
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Current Knowledge ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Renal Sympathetic Denervation ◽  
Significant Group ◽  
Arterial Blood ◽  
Optimal Blood Pressure

Treatment-resistant hypertension, or resistant hypertension (RH), is defined as arterial hypertension (AH) despite treatment with three properly dosed antihypertensive drugs, at least one of which is a diuretic. Resistant hypertension is associated with an increased incidence of adverse cardiovascular events, renal impairment, and increased mortality. The main treatment of patients with RH is based on maximizing doses of antihypertensive drugs from different groups and adding drugs with complementary mechanisms of action. Despite the combination treatment involving multiple antihypertensive drugs, a small but significant group of patients remains with uncontrolled hypertension, emphasizing the need to find and put into practice new therapies to lower high arterial blood pressure (BP). Among these new methods of treatment, the most promising is the renal sympathetic denervation, showing positive results with the second generation devices. This review summarizes current knowledge about the treatment of RH, with an emphasis on new therapeutic strategies to achieve optimal blood pressure control.

scholarly journals Blood Pressure Control Provides Less Cardiovascular Protection in Adults With Than Without Apparent Treatment-Resistant Hypertension

2016 ◽  
Vol 18 (8) ◽  
pp. 817-824 ◽  
Author(s):  
Brent M. Egan ◽  
Bo Kai ◽  
C. Shaun Wagner ◽  
Joseph H. Henderson ◽  
Archie H. Chandler ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Resistant Hypertension ◽  
Pressure Control ◽  
Treatment Resistant ◽  
Cardiovascular Protection

scholarly journals Drug compliance among hypertensive patients in Kassala, Eastern Sudan

2000 ◽  
Vol 6 (1) ◽  
pp. 100-105
Author(s):  
A. G. El Zubier ◽  
A. A. Husain ◽  
I. A. Suleimati ◽  
Z. A. Hamid
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Compliance Rate ◽  
Pressure Control ◽  
Cross Sectional Study ◽  
Drug Compliance ◽  
Cross Sectional ◽  
Uncontrolled Blood Pressure ◽  
Hypertensive Patients ◽  
Eastern Sudan

A cross-sectional study of hypertensive patients was conducted and drug compliance was estimated. Factors associated with compliance, status of blood pressure control and occurrence of complications were assessed. Compliance was 59.6% as measured with the pill count method. We found 92% of compliant patients had controlled blood pressure in comparison with 18% of non-compliant patients, and 30.1% of the compliant patients had complications in comparison with 46.3% of the non-compliant patients. While the compliance rate was reasonable, 36.8% of patients were non-compliant because they could not afford to buy antihypertensive drugs. Inability to buy drugs was negatively and significantly associated with compliance. These patients experienced uncontrolled blood pressure and other complications

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