Achieving optimal blood pressure via a therapeutic concordance protocol in therapy-resistant hypertension reduced kidney function decline compared to uncontrolled patients (8.5% vs 23.4%, p<0.012).
Cohort (n=279)
Does a therapeutic concordance protocol improve blood pressure control and prevent kidney function decline in patients with true therapy-resistant hypertension?
A therapeutic concordance protocol involving periodic verification of pharmacological regimens can help achieve optimal blood pressure control and reduce kidney function decline in patients with true therapy-resistant hypertension.
Absolute Event Rate: 8.5% vs 23.4%
p-value: p=< 0.012
INTRODUCTION: An empathetic approach may be particularly useful in patients with therapy-resistant hypertension (TRH), defined as the failure to achieve target blood pressure (BP) despite a maximal doses of 3 antihypertensive drugs including a diuretic. However, the effects of therapeutic concordance have not been determined in hypertensive patients. METHODS: We designed a study to explore the impact of therapeutic concordance in patients with TRH, who were included in an intervention arm based on a protocol in which trained personnel periodically verified the pharmacological regimen of these patients. RESULTS: From a cohort of 5331 hypertensive patients followed-up for 77.64 ± 34.44 months, 886 subjects were found to have TRH; of these, 322 had apparent TRH (aTRH: uncontrolled office BP but optimal home BP) and 285 refused to participate in a second follow-up study, yielding a population of 279 patients with true TRH (tTRH). These tTRH patients were followed according to the therapeutic concordance protocol for 91.91 ± 54.7 months, revealing that 210 patients (75.27%) remained with uncontrolled BP (uncontrolled tTRH, Group I) while 69 patients (24.73%) reached an optimal BP control (average BP <140/90 mmHg in at least 50% of follow-up visits, Group II). Strikingly, at the end of the second follow-up, the percentage of patients displaying a decline in kidney function was significantly smaller in Group II than in Group I (8.5% vs 23.4%, p < 0.012). CONCLUSIONS: Taken together, our findings indicate for the first time that therapeutic concordance significantly improves the outcome of antihypertensive treatment in a population of patients with TRH.
Trimarco et al. (Wed,) conducted a cohort in therapy-resistant hypertension (TRH) (n=279). Therapeutic concordance protocol vs. Uncontrolled blood pressure was evaluated on Decline in kidney function (p=< 0.012). Achieving optimal blood pressure via a therapeutic concordance protocol in therapy-resistant hypertension reduced kidney function decline compared to uncontrolled patients (8.5% vs 23.4%, p<0.012).