Key result
Directly observed therapy unmasks non-adherence by markedly lowering blood pressure in apparent refractory hypertension.
Why the study?
There is no gold standard to assess adherence in suspected refractory hypertension, and directly observed therapy is not widely used in Russian clinical practice.
Does directly observed therapy identify medication non-adherence in a patient with apparent refractory hypertension?
Case Report (n=1)
No
Does directly observed therapy identify medication non-adherence in a patient with apparent refractory hypertension?
Directly observed therapy effectively unmasks poor medication adherence in patients with apparent refractory hypertension, preventing unnecessary escalation of care such as renal denervation.
May aid identification of non-adherence in apparent refractory hypertension; single case leaves open need for prospective studies.
Refractory arterial hypertension (RefHTN) is an extreme phenotype of resistant hypertension (RHTN), is associated with utmost poor clinical sequelae. True RHTN occurs in 10-15 % of treated patients. Up to half of them meet the definition of RefHTN, but another ~50 % are eventually diagnosed with ‘pseudo’-RHTN. Partial or complete non-adherence are among its the main causes. To date, there is no ‘gold’ standard to assess adherence. Directly observed therapy (DOT) is a promising non-invasive method to assess patient compliance. The wellknown abroad, DOT is not widely used in Russian clinical practice. In this short report we demonstrate a case of DOT in a patient with apparent RefHTN.
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Ionov et al. (2022) conducted a case report in Apparent refractory hypertension (n=1). Directly observed therapy (DOT) was evaluated on Change in blood pressure following directly observed therapy. Directly observed therapy revealed a profound blood pressure reduction after medication intake, confirming non-adherence and ruling out true refractory hypertension.
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