Many patients with presumed drug-resistant blood pressure are not taking medications

MONDAY, Sept. 10, 2018 (American Heart Association) – For about one in five people with hard-to-treat or resistant hypertension, they simply do not take prescribed medications, according to a new study.

Drug-resistant hypertension appears to be increasing and occurs when blood pressure remains above normal even after the patient has received three medications for hypertension or more. High blood pressure is a well-known risk factor for heart attacks, strokes, kidney disease and other chronic conditions.

The new study, reported Saturday at the 2018 joint scientific sessions on hypertension of the American Heart Association in Chicago, used a simple and inexpensive intervention to eliminate truly resistant patients: watch them actually take their drugs.

This approach calls itself a "direct observation therapy," said Dr. Swapnil Hiremath, one of the study's researchers and an associate professor of medicine at the University of Toronto. Ottawa in Canada. A group of 48 patients suspected of resistant hypertension who reported taking their medications – claims substantiated by pharmaceutical records – entered the clinic, where health care providers saw them taking their medications against the drug. ;hypertension. The blood pressure levels of the patients were monitored until the medications took effect. And the patients were sent home with portable blood pressure monitors 24 hours a day.

When patients returned to the clinic the next day, 10 of the 48 patients had lower blood pressure than the intended goal.

"It was kind of dramatic for us, the significant change in blood pressure, all we did was look at people taking their medications," Hiremath said.

Patients visited the clinic a month later for regular blood pressure monitoring without direct observational therapy, and nine other patients had controlled blood pressure.

The study did not examine why patients were not taking their medications, but Hiremath said the common reasons for non-compliance included side effects and a lack of awareness of the need to take medication. medications for a chronic disease without symptoms. Hiremath noted that it is there that high blood pressure gets its nickname: "where" the silent killer, "he said.

Doctors need to know if patients have really resistant hypertension so that they only intensify the treatment if it's really necessary, said Dr. Robert M. Carey, a professor of medicine at the University of Toronto. University of Virginia. and American College of Cardiology.

He said the new findings confirm what other studies have shown on the frequency with which patients with hypertension do not take their medications.

Uncontrolled blood pressure, additional tests and changes in drug treatment can harm patients' health, take time for providers and costly for health care, adds Carey, adding that the ultimate day solution for Ensure that they follow the doctor's orders.

Hiremath said, "What happens next is an old-fashioned medicine: you sit down with the patient and you'll know what's going on. Do they take their medications and, if not, why not?

"It may be all you need to do, what we are talking about is not rocket science," he said.