Sebastian Ewen asks questions to Bernard Waeber, co-author of Assessment of drug compliance in patients with high blood pressure resistant to antihypertensive therapy, article published in EuroIntervention Journal Supplement on Resistant Hypertension Treatments, May 2013.
The persistence of high blood pressure under antihypertensive treatment (resistant hypertension) entails an increased cardiovascular risk. It occurs in three of ten treated hypertensive patients, and has several possible contributing factors, notably insufficient therapeutic adherence. There are a number of ways to evaluate whether patients take their medication as prescribed. These include interviewing the patient, pill counting, prescription follow-up, assay of drugs in blood or urine, and use of electronic pill dispensers. None is perfect. However, the essential is to discuss with the patient the importance of complying with the treatment as soon as it is prescribed for the first time, and not waiting for the appearance of resistant hypertension. The measurement of blood pressure outside the medical office and the monitoring of adherence may help to identify patients in whom hypertension is truly resistant and so to tailor the measures required to improve the control of blood pressure in the most appropriate manner.
Sebastian Ewen: How do you monitor the compliance of your patients in clinical routine?
Bernard Waeber: I don’t monitor routinely compliance in my daily practice. I discuss however from the beginning about the importance of taking drugs as prescribed and strongly recommend my patients to contact me if they are considering to stop therapy. In patients with treatment-resistant hypertension documented by ABPM and/or home BP monitoring, I may ask my patients to monitor compliance using an electronic device.
Sebastian Ewen: Do you think a low adherence is the most common cause of poor blood pressure control in patients with resistant hypertension?
Bernard Waeber: Poor compliance is a major cause of unsatisfactory BP control, but I don’t think that it is the major cause. Other causes are also very important, including undertreatment due to clinical inertia and apparent resistance due to a white-coat effect.
Sebastian Ewen: Where do you see the role of analysis for antihypertensive drugs or their corresponding metabolites in urine to control the compliance of patients with resistant hypertension in clinical routine?
Bernard Waeber: Looking for the presence of drugs or their metabolites in urines is not a good way to monitor compliance. It is quite usual that poor compliers take drugs a few days before the day of the visit. Anyway, there is no simple way to analyse urins and this may be too expensive for routine practice.
Sebastian Ewen: Where do you see the role of a general practitioner in order to improve compliance in patients with resistant hypertension?
Bernard Waeber: The role of practitioners is key. They have to spend time to explain their patients why they should take their regularly their drugs. The patient-doctor relationship is in this respect of pivotal importance.
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