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Original research
Directly observed therapy for resistant/refractory hypertension diagnosis and blood pressure control
  1. Andrea Pio-Abreu1,
  2. Fernanda Trani-Ferreira1,
  3. Giovanio V Silva1,
  4. Luiz A Bortolotto2,
  5. Luciano F Drager1,2
  1. 1Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
  2. 2Unidade de Hipertensão, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
  1. Correspondence to Dr Luciano F Drager, Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; luciano.drager{at}incor.usp.br

Abstract

Objective To test the impact of directly observed therapy (DOT) at hospital for checking not only adherence/diagnosis in patients with resistant (RHTN) and refractory (RefHTN) hypertension but also blood pressure (BP) control after hospital discharge.

Methods During 2 years, Brazilian patients with clinical suspicion of RHTN/RefHTN after several attempts (≥3) to control BP in the outpatient setting were invited to perform DOT (including low-sodium diet and supervised medications intake) at the hospital. RHTN and RefHTN were categorised using standard definitions. After hospital discharge, we evaluated the BP values and the number of antihypertensive drugs prescribed by physicians who were not involved with the investigation.

Results We studied 83 patients clinically suspected for RHTN (31%) and RefHTN (69%) (mean age: 53 years; 76% female; systolic BP 177±28 mm Hg and diastolic BP 106±21 mm Hg; number of antihypertensive drugs: 5.3±1.3). DOT confirmed RHTN in 77%, whereas RefHTN was confirmed in only 32.5%. The number of antihypertensive drugs reduced to 4.5±1.3 and systolic/diastolic BP at hospital discharge reduced to 131±17 mm Hg/80±12 mm Hg. After hospital discharge, systolic BP remained significantly lower than the last outpatient visit prehospital admission (delta changes (95% CI): 1 month: −25.7 (−33.8 to −17.6) mm Hg; 7 months: −27.3 (−35.5 to −19.1) mm Hg) despite fewer number of antihypertensive classes (1 month: −1.01 (−1.36 to −0.67); 7 months: −0.77 (−1.11 to −0.42)). Similar reductions were observed for diastolic BP.

Conclusions DOT at hospital is helpful not only in confirming/excluding RHTN/RefHTN phenotypes, but also in improving BP values and BP control and in reducing the need for antihypertensive drugs after hospital discharge.

  • Hypertension
  • Medication Adherence

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors Study design: AP-A, LAB and LFD. Data collection: all authors. Data analysis and statistical analysis: AP-A and LFD. Manuscript draft: AP-A and LFD. Critical revision, editing and approval of the final manuscript: all authors. AP-A and LFD are responsible for the overall content as guarantors.

  • Funding This work was supported by a research grant from FAPESP (2019/23496-8).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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