Key result
Adherence >90% to standardized triple therapy was associated with 24-hour blood pressure control in patients with apparent resistant hypertension (OR 14.1; 95% CI 1.1-173.3; p=0.039).
Why the study?
Poor drug adherence and inadequate regimens frequently cause poor blood pressure control in apparent resistant hypertension, prompting evaluation of a strategy combining standardised triple therapy with electronic adherence monitoring.
Does a strategy combining standardised triple therapy and electronic adherence monitoring improve 24h ambulatory systolic blood pressure control in adult patients with apparent resistant hypertension?
Observational (n=48)
Yes
Does a strategy combining standardised triple therapy and electronic adherence monitoring improve 24h ambulatory systolic blood pressure control in adult patients with apparent resistant hypertension?
Odds Ratio: 14.1 (95% CI 1.1–173.3)
p-value: p=0.039
A simplified standardized triple antihypertensive therapy combined with electronic adherence monitoring normalizes systolic blood pressure in approximately half of patients with apparent resistant hypertension.
Adherence monitoring may aid BP control in resistant hypertension; hypothesis-generating and requires randomized confirmation of combined strategies.
Purpose Poor adherence to drug therapy and inadequate drug regimens are two frequent factors responsible for the poor blood pressure (BP) control observed in patients with apparent resistant hypertension. We evaluated the efficacy of an antihypertensive management strategy combining a standardised therapy with three long acting drugs and electronic monitoring of drug adherence in patients with apparent resistant hypertension.Materials and Methods In this multicentric observational study, adult patients with residual hypertension on 24 h ambulatory BP monitoring (ABMP) despite the use of three or more antihypertensive drugs could be included. Olmesartan/amlodipine (40/10 mg, single pill fixed-dose combination) and chlorthalidone (25 mg) were prescribed for 3 months in two separated electronic pills boxes (EPB). The primary outcome was 24 h ambulatory systolic BP (SBP) control at 3 months, defined as mean SBP <130 mmHg.Results We enrolled 48 patients (36.0% women) of whom 35 had complete EPB data. After 3 months, 52.1% of patients had 24 h SBP <130 mmHg. 24 h SBP decreased by respectively −9.1 ± 15.5 mmHg, −22.8 ± 30.6 mmHg and −27.7 ± 16.6 mmHg from the tertile with the lowest adherence to the tertile with the highest adherence to the single pill combination (p = 0.024). A similar trend was observed with tertiles of adherence to chlorthalidone. Adherence superior to 90% was associated with 24 h systolic and diastolic blood pressure control in multiple logistic regression analysis (odds ratio = 14.1 (95% confidence interval 1.1–173.3, p = 0.039).Conclusions A simplified standardised antihypertensive therapy combined with electronic monitoring of adherence normalises SBP in about half of patients with apparent resistant hypertension. Such combined management strategy enables identifying patients who need complementary investigations and those who rather need a long-term support of their adherence.
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Polychronopoulou et al. (2021) conducted an observational in apparent resistant hypertension (n=48). Standardised triple therapy and electronic monitoring of drug adherence was evaluated on 24 h ambulatory systolic BP (SBP) control at 3 months, defined as mean SBP <130 mmHg (OR 14.1, 95% CI 1.1-173.3, p=0.039). Adherence >90% to standardized triple therapy was associated with 24-hour blood pressure control in patients with apparent resistant hypertension (OR 14.1; 95% CI 1.1-173.3; p=0.039).
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