Apparent resistant hypertension and medication adherence

Abstract

Resistant hypertension is defined as hypertension that remains and requires four or more medications for treatment. Resistant hypertension differs from uncontrolled hypertension in that patients with the latter may have poorly controlled blood pressure resulting from poor adherence and/or a suboptimal treatment regimen. Factors contributing to inappropriately labeled treatment-resistant hypertension, or ‘pseudoresistance,’ include poor blood pressure measurement technique, the white coat effect and poor adherence to prescribed therapy. Good measurement technique is crucial and includes allowing the patient to sit quietly in a relaxed environment for 3–5 min, the use of a correctly sized cuff and correct positioning of the arm at heart level. It is important to make a distinction between uncontrolled and resistant hypertension, as patients with uncontrolled blood pressure resulting from lack of adherence do not require potentially costly and harmful diagnostic evaluations or treatment changes that are appropriate for patients with truly resistant hypertension. Furthermore, nonadherence to treatment has been shown to result in substantial morbidity and mortality.1