A Fatal Case of Therapeutic Non-Adherence in Hypertension

Objective: This case report aims to reinforce the importance of therapeutic adherence and multidisciplinary approach in the effectiveness of treatment for hypertension. Design and method: To write this case report, an exhaustive review of the patient's clinical process was carried out, considering his follow-up in primary health care, hospitalizations and hospital consultations of various specialties. Results: This case report describes the clinical case of a 57-year-old male patient, with a personal history of hypertension diagnosed 10 years ago, complicated with mild concentric left ventricular hypertrophy. He also had anxiety disorder, without other relevant personal history. The systolic blood pressure profile was 150-220 mmHg and the diastolic profile was 90-120 mmHg. Since diagnosis, he was medicated with multiple associations of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics and beta blockers and followed up in an Internal Medicine consultation from 2015 to 2017, always persisting poor therapeutic adherence and suspension of medication on his own initiative due to alleged adverse effects. In 2021, he was referred to Psychiatry consultation due to therapeutic refusal, having been diagnosed with probable paranoid personality disorder. Due to the lack of insight into the psychogenic component and resistance to therapeutic interventions, it was decided to maintain an expectant attitude towards psychiatric pathology and consequently to hypertension. In 2023, the patient died suddenly at home, at the age of 57, of undetermined causes. He underwent a forensic autopsy, identifying a stroke as the cause of death. Conclusions: In Portugal, cerebrovascular diseases represent the main cause of mortality, with high blood pressure contributing to 51% of deaths due to stroke. Controlling modifiable risk factors, with a particular focus on hypertension, is essential to reduce premature mortality from cerebrovascular disease. Family doctors are in a privileged position to monitor hypertensive patients. This case report serves as a warning so that they can identify early therapeutic adherence problems, promoting a multidisciplinary approach with the aim of resolving them.