Association between Therapeutic Adherence and the Profile of Patients with Resistant Hypertension

Abstract

Background: Resistant hypertension (RH) consists of increased blood pressure (BP) despite the use of 3 or more antihypertensives or BP control only when is use of 4 or more antihypertensives. It is fundamental to exclude pseudoresistance, which can be attributed to poor therapeutic adherence. Adherence evaluation, generally by the Morisky-Grenn test, is important because, when appropriate, it is associated with fewer cardiovascular complications and better BP control. Objectives: To evaluate the adherence of patients with RH and to investigate its relation with epidemiological, anthropometric and clinical characteristics, as well as to estimate the prevalence of pseudoresistance and to outline strategies to improve adherence. Methods: Retrospective observational cohort from an interview with patients followed at an outpatient clinic for RH. Therapeutic adherence, demographic, anthropometric data, cardiovascular risk factors, comorbidities, complementary exams and BP level were collected. One-way ANOVA and Student's t-tests were used for normal variables, and the Kruskal-Wallis and Mann-Whitney tests were used for non-normal tests. Categorical variables were compared using the Chi-Square test. We considered a 5% significance level in all tests. Results: 217 individuals were included. Of these, 17% had poor adherence. Epidemiological and clinical characteristics, complications, comorbidities, BP level or drugs used were statistically insignificant between groups. The poor adherence group used significantly more drugs (p = 0.0313) and 28% of pseudoresistance was estimated. Conclusions: Most of the individuals presented good therapeutic adherence by the Morisky test. Only the number of antihypertensive drugs had a statistically significant influence on adherence, while the epidemiological, anthropometric and clinical characteristics were statistically insignificant.

Pharmaceutical Care in Primary Care: an Experience with Hypertensive Patients in the North of Brazil

“…21 Uncontrolled blood pressure has been frequently associated with low treatment adherence. 3,22 Araújo & Aras Junior 23 reported that most of their studied patients had uncontrolled hypertension, regardless of treatment adherence. However, the authors observed an expected trend: patients with controlled hypertension had good treatment adherence, and most of patients with uncontrolled hypertension had poor adherence.…”

“…The patient was instructed about the correct use of medication, and blood pressure levels were normalized after that. However, according to Araújo & Aras Junior, 23 although the Morisky-Green test is the most used method to quantify adherence to anti-hypertensive treatment in Brazil, enabling comparison between studies, the instrument may not be the most appropriate considering its low sensitivity (43.6%).…”

The Challenge of Controlling Resistant Hypertension

“…This issue of the International Journal of Cardiovascular Sciences presents the results of the study entitled "Association between Therapeutic Adherence and the Profile of Patients with Resistant Hypertension", by Araújo and Aras Junior. 6 The study was conducted with hypertensive patients seen in an outpatient clinic of a university hospital in Brazil and adds to the knowledge about the management of resistant hypertension in our country. 6 The study brings encouraging results, showing that 83% of patients had good adherence to treatment, maybe because they were seen in a tertiary health care institution.…”

“…6 The study was conducted with hypertensive patients seen in an outpatient clinic of a university hospital in Brazil and adds to the knowledge about the management of resistant hypertension in our country. 6 The study brings encouraging results, showing that 83% of patients had good adherence to treatment, maybe because they were seen in a tertiary health care institution. Twenty percent of patients had pseudoresistant hypertension and 17% refractory hypertension (patients with uncontrolled hypertension even taking five or more antihypertensive drugs).…”

“…However, even with good adherence to treatment, only 38% of the individuals had controlled blood pressure. 6 In view of the high risk of resistant hypertension, blood pressure control of patients with this condition is imperative. However, for different reasons, control has been shown to be less than desirable, at least in our country.…”