Patient noncompliance not to blame for treatment-resistant hypertension

המידע באדיבות מדיקונטקסט
Last Updated: 2001-07-20 13:35:47 EDT (Reuters Health)

By Anthony J. Brown, MD

LONDON (Reuters Health) – Patient noncompliance with antihypertensive medications does not appear to be a common cause of treatment-resistant hypertension, according to a report published in the July 21st issue of the British Medical Journal.

Dr. Edouard Battegay and colleagues, from University Hospital, in Basle, Switzerland, assessed the relationship between treatment compliance and the development of treatment-resistant hypertension in 103 medical outpatients who were taking two or more antihypertensive medications for at least 4 weeks.

A medical-event monitoring system was used to determine treatment compliance. Based on 12-hour daytime ambulatory monitoring, a blood pressure of 135/85 mm Hg or greater in patients 60 years of age or younger or a pressure of 155/90 mm Hg or greater in patients older than 60 indicated treatment-resistant hypertension.

Of the study group, 86 patients took at least 80% of the prescribed doses and were considered treatment compliant, while the remainder took less than this percentage were considered noncompliant, the authors note. Relatively equal percentages of patients with treatment-resistant and treatment-responsive hypertension were noncompliant with therapy.

"In my personal experience, most cases of therapy-resistant hypertension did not involve a lack of compliance," Dr. Battegay told Reuters Health. "So we designed a prospective study to investigate whether compliance was associated with therapy-resistant hypertension," he added. "Our study shows that there was no association between the two," he said.

Dr. Battegay said that the current findings are not meant to suggest that treatment compliance is unimportant, just that it does not seem to be a major determinant of treatment-resistant hypertension.

"In most cases, the patient is not to blame for a lack of response to therapy," Dr. Battegay said. Even when patients are fully compliant with their treatment regimens, treatment-resistant hypertension still occurs, he said. "This result indicates that we don't have adequate antihypertensive medications to treat a number of patients," he added.

BMJ 2001;323:142-146.

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