Therapeutic concordance improves blood pressure control in patients with resistant hypertension

Abstract

Introduction: An empathetic approach may be particularly useful in patients with therapy-resistant hypertension (TRH), defined as the failure to achieve target blood pressure (BP) despite a maximal doses of 3 antihypertensive drugs including a diuretic. However, the effects of therapeutic concordance have not been determined in hypertensive patients.

Methods: We designed a study to explore the impact of therapeutic concordance in patients with TRH, who were included in an intervention arm based on a protocol in which trained personnel periodically verified the pharmacological regimen of these patients.

Results: From a cohort of 5331 hypertensive patients followed-up for 77.64 ± 34.44 months, 886 subjects were found to have TRH; of these, 322 had apparent TRH (aTRH: uncontrolled office BP but optimal home BP) and 285 refused to participate in a second follow-up study, yielding a population of 279 patients with true TRH (tTRH). These tTRH patients were followed according to the therapeutic concordance protocol for 91.91 ± 54.7 months, revealing that 210 patients (75.27%) remained with uncontrolled BP (uncontrolled tTRH, Group I) while 69 patients (24.73%) reached an optimal BP control (average BP <140/90 mmHg in at least 50% of follow-up visits, Group II). Strikingly, at the end of the second follow-up, the percentage of patients displaying a decline in kidney function was significantly smaller in Group II than in Group I (8.5% vs 23.4%, p < 0.012).

Conclusions: Taken together, our findings indicate for the first time that therapeutic concordance significantly improves the outcome of antihypertensive treatment in a population of patients with TRH.

Keywords: Adherence; Blood pressure; Concordance; EGFR; Hypertension; Pharmacologic resistance.

Fig. 1.

Flowchart of the study. TRH: therapy-resistant hypertension; aTRH: apparent therapy-resistant hypertension; BP: blood pressure; tTRH: true therapy-resistant hypertension.

Fig. 2.. Inverse correlation between pulse pressure and kidney function.

GFR_EPI: glomerular filtration rate measured by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation.