Characteristics, drug combinations and dosages of primary care patients with uncontrolled ambulatory blood pressure and high medication adherence
Open accessAbstract
Most studies on the prevalence and determinants of resistant hypertension (RH) do not account for white coat hypertension, medication non-adherence, or use of suboptimal treatment dosages. We studied the characteristics, drug combinations, and dosages of patients on at least three antihypertensives of different classes who had uncontrolled blood pressure on 24-hour ambulatory blood pressure monitoring and high medication adherence measured by electronic monitoring. The data were collected as part of the baseline measures of a hypertension control trial. Of 140 monitored primary care patients, all with uncontrolled office blood pressure, 69 (49%) were on at least three antihypertensives of different classes. Of these 69, 15 (22%) were controlled on ambulatory blood pressure monitoring, 20 (29%) were uncontrolled and non-adherent, leaving only 34 (49%) adherent to their medications and having uncontrolled ambulatory hypertension (uncontrolled RH). Thirty-one (91%) of the 34 uncontrolled RH patients were prescribed a diuretic, of which 24 were on hydrochlorothiazide 25 mg. Less than half of the patients on angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or calcium channel blocker were prescribed maximal doses of these agents. Half of the RH can be attributed to white coat effect and poor medication adherence, and all of the remaining patients were on apparently suboptimal drug combinations and/or dosages. Primary care physicians need to be educated regarding the optimal treatment of RH.
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Suboptimal antihypertensive drug regimens substantively contribute to the likelihood of being diagnosed with resistant hypertension.
“Suboptimal antihypertensive drug regimens substantively contribute to the likelihood of being diagnosed with RH.41,60,61”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [61]
Drug treatment regimens in resistant hypertension infrequently include either spironolactone or chlorthalidone, 2 highly effective blood pressure-lowering agents, in this high-risk group of hypertensives.
“Accordingly, drug treatment regimens in RH infrequently include either spironolactone or chlorthalidone, 2 highly effective BP-lowering agents, in this high-risk group of hypertensives.60,61”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [61]
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References 31 · Cited by 48
- Authors
- Grigoryan, L., Pavlik, V. N., & Hyman, D. J.
- Affiliations
- Baylor College of Medicine (US)
- Corresponding author
- Grigoryan, Larissa
- Venue
- Journal of the American Society of Hypertension
- Publisher
- Elsevier BV
- Published
- 2013-11
- Volume
- 7
- Issue
- 6
- Pages
- 471-476
- ISSN
- 1878-7436 (ISSN-L)
- 1933-1711
- PMC
- PMC3883386
- OpenAlex
- W2063387527
- Cited by
- 48
- References
- 31
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 4 · 2022: 1 · 2021: 2 · 2020: 5 · 2019: 11 · 2018: 5 · 2017: 3 · 2016: 6 · 2015: 3 · 2014: 5 · 2013: 1
- FWCI
- 3.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Society of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL078589)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- resistant hypertension, white coat hypertension, medication adherence, combination antihypertensive therapy, ambulatory blood pressure monitoring, hydrochlorothiazide, diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, primary care patients, hypertension control
- MeSH terms
- Adult, Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure, Calcium Channel Blockers, Diuretics, Dose-Response Relationship, Drug, Drug Resistance, Drug Therapy, Combination, Female, Humans, Hypertension, Male, Middle Aged, Primary Health Care, Blood Pressure Monitoring, Ambulatory, Medication Adherence, White Coat Hypertension
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