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Refractory hypertension due to lack of treatment compliance in a 37 year old woman


Abstract


BACKGROUND: Therapeutic inertia and lack of compliance are the main
barriers to hypertension control
OBJECTIVES: Presentation of a case illustrating the importance of
proper adherence to blood pressure and a detailed anamnesis in
patients with apparent refractory hypertension.
METHODS: Review of the clinical record.
RESULTS: A female patient had been diagnosed of hypertension 3 years
ago, with SBP around 150-160 mmHg and DBP around 90-100 mmHg.
Ambulatory Blood Pressure Monitoring (AMBP) was performed while
untreated, showing a normal dipper pattern, with average BP 141/93mmHg
(diurnal) and 115/69mmHg (nocturnal); the respective HR were 81 and 68
bpm. The peak SBP was156 mmHg (2:30 p.m.). No cause of secondary
hypertension or target organ damage had been found.
The patient never achieved adequate BP control despite multiple
permutations and combinations of drugs. She was prescribed up to 12
different patterns of antihypertensive treatment; the final
combination before referral to our Hypertension Clinic was:
Cardesartan 16 mg + Torasemide 10 mg + Amlodipine10mg + Doxazosin 10
mg + Bisoprolol 10mg +Spironolactone 50 mg. Reinterrogating the
patient in order to clarify the inefficiency of the antihypertensive
treatment, she finally admitted that she had never taken it regularly
and had taken at most one tablet daily. An agrrement was made: She
would take only one daily pill (Valsartan 80 mg) avoiding omissions.
After 2 weeks the ABPM was repeated and the results were: average BP
123/83mmHg (diurnal) and 116/73mmHg (nocturnal); the respective HR
were 75 and 77 bpm. It clearly showed that she had a pseudorefractory
hypertension, caused by lack of compliance.
CONCLUSIONS: This case illustrates that in patients with hypertension
labeled as refractory it is essential to obtain a detailed anamnesis
and assessment of the level of compliance, before prescribing drugs
and explorations which can entail high costs and side effects.

 

Poster
non-peer-reviewed

Refractory hypertension due to lack of treatment compliance in a 37 year old woman


Author Information

Sara Quintana Arroyo Corresponding Author

Endocrinology and Nutrition, Hospital Universitario de Gran Canaria Doctor Negrín


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  • Author Information
    Sara Quintana Arroyo Corresponding Author

    Endocrinology and Nutrition, Hospital Universitario de Gran Canaria Doctor Negrín

    Poster Information
    Meeting

    First International Online BioMedical Conference September 09, 2015 - September 12, 2015

    Publication history

    Received by Cureus: September 09, 2015
    Published: September 09, 2015

    License

    This is an open access poster distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract


BACKGROUND: Therapeutic inertia and lack of compliance are the main
barriers to hypertension control
OBJECTIVES: Presentation of a case illustrating the importance of
proper adherence to blood pressure and a detailed anamnesis in
patients with apparent refractory hypertension.
METHODS: Review of the clinical record.
RESULTS: A female patient had been diagnosed of hypertension 3 years
ago, with SBP around 150-160 mmHg and DBP around 90-100 mmHg.
Ambulatory Blood Pressure Monitoring (AMBP) was performed while
untreated, showing a normal dipper pattern, with average BP 141/93mmHg
(diurnal) and 115/69mmHg (nocturnal); the respective HR were 81 and 68
bpm. The peak SBP was156 mmHg (2:30 p.m.). No cause of secondary
hypertension or target organ damage had been found.
The patient never achieved adequate BP control despite multiple
permutations and combinations of drugs. She was prescribed up to 12
different patterns of antihypertensive treatment; the final
combination before referral to our Hypertension Clinic was:
Cardesartan 16 mg + Torasemide 10 mg + Amlodipine10mg + Doxazosin 10
mg + Bisoprolol 10mg +Spironolactone 50 mg. Reinterrogating the
patient in order to clarify the inefficiency of the antihypertensive
treatment, she finally admitted that she had never taken it regularly
and had taken at most one tablet daily. An agrrement was made: She
would take only one daily pill (Valsartan 80 mg) avoiding omissions.
After 2 weeks the ABPM was repeated and the results were: average BP
123/83mmHg (diurnal) and 116/73mmHg (nocturnal); the respective HR
were 75 and 77 bpm. It clearly showed that she had a pseudorefractory
hypertension, caused by lack of compliance.
CONCLUSIONS: This case illustrates that in patients with hypertension
labeled as refractory it is essential to obtain a detailed anamnesis
and assessment of the level of compliance, before prescribing drugs
and explorations which can entail high costs and side effects.

 

Sara Quintana Arroyo

Endocrinology and Nutrition, Hospital Universitario de Gran Canaria Doctor Negrín

For correspondence:
sara_quintana@yahoo.es

Sara Quintana Arroyo

Endocrinology and Nutrition, Hospital Universitario de Gran Canaria Doctor Negrín

For correspondence:
sara_quintana@yahoo.es

Sara Quintana Arroyo

Endocrinology and Nutrition, Hospital Universitario de Gran Canaria Doctor Negrín

For correspondence:
sara_quintana@yahoo.es

Converted poster internacional