Directly Observed Therapy in Hypertension (DOT-HTN)

  • Ulla Hjørnholm
  • Mikaela Aamodt
  • Anne Cecilie Larstorp
  • Fadl Elmula M. Fadl Elmula
  • Aud Høieggen
  • Marit Helen Andersen
  • Sverre E. KjeldsenEmail author
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)


Directly observed therapy (DOT), or witnessed intake of hypertensive patients’ prescribed medication - hereafter called DOT-HTN, has been introduced in hypertension research and reported in the literature since 2011 with emphasis on treatment resistant hypertensive (TRH) patients. The aim of this review is to identify how the DOT-HTN procedure has been applied in ongoing and published research. Researchers from four nations were identified being engaged in research of DOT in hypertensive patients. Five ongoing trials of different methodologies were identified, of which three investigated the use of DOT-HTN. Ten published reports, hereof five studies, were identified, and ten key points of information, including level of care, were identifiable in eight of ten reports describing the DOT-HTN procedures. Three reports had rather similar procedures with observed full dose of morning medications and a maximum of 2 hours of post-DOT-HTN observation. Three reports had longer observation time, two of them with medication administration intervals, and blood pressure measurement intervals. Two were case reports, describing severe post-DOT-HTN adverse reactions, contributing with important safety information. All reports either described safety measures or discussed the safety of the procedure. In eight of ten publications, no characteristics of the patients undergoing the procedure were described. Thus, reports are scarce and describe different DOT-HTN procedures, as well as lack data on patient characteristics. It is important that future research characterizes the patients who are found to be non-adherent after directly observed therapy of antihypertensive medications. It is equally important that randomized controlled trials are conducted, to investigate whether the DOT-HTN procedure is safe, and has effect on blood pressure in uncontrolled or treatment resistant hypertensive patients. Ethical challenges regarding the use of DOT-HTN exist and must be debated.


Adherence Blood pressure Cardiovascular disease Compliance Drug treatment Direct observed therapy Hypertension Persistence Treatment resistant hypertension 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ulla Hjørnholm
    • 1
  • Mikaela Aamodt
    • 2
  • Anne Cecilie Larstorp
    • 1
    • 3
  • Fadl Elmula M. Fadl Elmula
    • 1
    • 4
    • 5
  • Aud Høieggen
    • 1
    • 6
    • 7
  • Marit Helen Andersen
    • 8
  • Sverre E. Kjeldsen
    • 1
    • 5
    • 7
    Email author
  1. 1.Section of Cardiovascular and Renal ResearchOslo University Hospital, UllevaalOsloNorway
  2. 2.University of Oslo Library, University of OsloOsloNorway
  3. 3.Department of Medical BiochemistryOslo University Hospital, UllevaalOsloNorway
  4. 4.Department of Acute MedicineOslo University Hospital, UllevaalOsloNorway
  5. 5.Department of CardiologyOslo University Hospital, UllevaalOsloNorway
  6. 6.Department of NephrologyOslo University Hospital, UllevaalOsloNorway
  7. 7.Institute for Clinical Medicine, University of OsloOsloNorway
  8. 8.Institute of Health and Society, University of OsloOsloNorway

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