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Can Drugs Work in Patients Who Do Not Take Them? The Problem of Non-adherence in Resistant Hypertension

  • Resistant Hypertension (E Pimenta, Section Editor)
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Abstract

Patients with uncontrolled hypertension on adequate combination and doses of blood pressure-lowering drugs present a diagnostic and therapeutic dilemma. Currently, hypertension guidelines point out uncommon causes of hypertension (either organic such as secondary hypertension or drugs/substances interfering with blood pressure-lowering drugs or causing hypertension) as a cause of hypertension resistance. Non-adherence to drugs, however, is equally, if not more, a cause of hypertension resistance. True resistance to pharmacotherapy is relatively uncommon, as in the majority of patients with non-adherence and/or secondary hypertension, the diagnosis of the problem may potentially lead to better control. Conventionally applied indirect methods to detect non-adherence are inadequate to uncover all cases of non-adherence, especially intentional non-adherence. Rigorous methods to detect non-adherence including direct observed therapy and measuring drug/metabolite levels in body fluids should be considered simultaneously if not before costly and invasive investigations for patients with difficult to control hypertension. However, data on the effectiveness of whether diagnosing non-adherence ultimately controls hypertension is still awaited.

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Acknowledgments

The authors would like to acknowledge research salary support from the Department of Medicine, University of Ottawa.

Compliance with Ethics Guidelines

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Conflict of Interest

Drs Ruzicka and Hiremath declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, University of Ottawa, 1967 Riverside Dr, Ottawa, ON, K1H7W9, Canada

    Marcel Ruzicka & Swapnil Hiremath

  2. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada

    Marcel Ruzicka

  3. Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1967 Riverside Dr, Ottawa, ON, K1H7W9, Canada

    Swapnil Hiremath

Authors
  1. Marcel Ruzicka
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  2. Swapnil Hiremath
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Correspondence to Swapnil Hiremath.

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This article is part of the Topical Collection on Resistant Hypertension

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Ruzicka, M., Hiremath, S. Can Drugs Work in Patients Who Do Not Take Them? The Problem of Non-adherence in Resistant Hypertension. Curr Hypertens Rep 17, 69 (2015). https://doi.org/10.1007/s11906-015-0579-4

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  • DOI: https://doi.org/10.1007/s11906-015-0579-4

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