The therapeutic concordance approach reduces adverse drug reactions in patients with resistant hypertension

Abstract

BackgroundAdverse drug reactions (ADRs) remain among the leading causes of therapy-resistant hypertension (TRH) and uncontrolled blood pressure (BP). We have recently reported beneficial results in BP control in patients with TRH adopting an innovative approach, defined as therapeutic concordance, in which trained physicians and pharmacists reach a concordance with patients to make them more involved in the therapeutic decision-making process.MethodsThe main scope of this study was to investigate whether the therapeutic concordance approach could lead to a reduction in ADR occurrence in TRH patients. The study was performed in a large population of hypertensive subjects of the Campania Salute Network in Italy (ClinicalTrials.gov Identifier: NCT02211365).ResultsWe enrolled 4,943 patients who were firstly followed-up for 77.64 ± 34.44 months, allowing us to identify 564 subjects with TRH. Then, 282 of these patients agreed to participate in an investigation to test the impact of the therapeutic concordance approach on ADRs. At the end of this investigation, which had a follow-up of 91.91 ± 54.7 months, 213 patients (75.5%) remained uncontrolled while 69 patients (24.5%, p < 0.0001) reached an optimal BP control. Strikingly, during the first follow-up, patients had complained of a total of 194 ADRs, with an occurrence rate of 68.1% and the therapeutic concordance approach significantly reduced ADRs to 72 (25.5%).ConclusionOur findings indicate that the therapeutic concordance approach significantly reduces ADRs in TRH patients.

Effectiveness of a nurse-led management intervention on systolic blood pressure among type 2 diabetes patients in Uganda: a cluster randomized trial

“…Our multicomponent intervention embraced the current concept of therapeutic concordance, which is premised on better communication and engaging patients in their treatment decisions, leading to better treatment outcomes and a low incidence of adverse drug reactions, which usually cause non-adherence and dropouts from treatment. In our intervention, we prescribed communication and patient support through periodical text messages and phone calls, which supported the patient in behavioral modification and taking their drugs [ 31 ]. Since systolic blood pressure is a major orchestrator of ASCVD [ 32 – 35 ], a reduction in systolic blood pressure also resulted in a reduction in the 10-year ASCVD risk score.…”