RT Journal Article
SR Electronic
T1 Directly observed therapy for resistant/refractory hypertension diagnosis and blood pressure control
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1952
OP 1956
DO 10.1136/heartjnl-2022-320802
VO 108
IS 24
A1 Andrea Pio-Abreu
A1 Fernanda Trani-Ferreira
A1 Giovanio V Silva
A1 Luiz A Bortolotto
A1 Luciano F Drager
YR 2022
UL http://heart.bmj.com/content/108/24/1952.abstract
AB 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.Data are available upon reasonable request.