A Refractory Disease or Refractory Patient
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See related article, pp 678–684
Adherence to lifestyle recommendations in concert with antihypertensive regimens provides the greatest reductions in blood pressure. Medication adherence, however, declines with number of prescribed agents and reduced communication time with the healthcare provider.1
The key to maximizing medication adherence is to ensure that the patient has confidence in the healthcare providers’ decisions and using single pill combinations, when possible. Resistant hypertension is a diagnosis of exclusion such that no secondary forms of hypertension can be implicated, and multiple medications are required to lower pressure toward goal.2 Hence, medication adherence in resistant hypertension is challenging.
Medication adherence is also vital to ensure accuracy of the resistant hypertension definition; yet, it has long been suspected that medication adherence by most patients is less than optimal. This is further supported by several investigations that assess medication adherence by measuring urinary metabolites of blood pressure–lowering medications.3,4
In this issue of Hypertension, de Jager et al5 report results from the randomized open-label SYMPATHY …