scholarly journals Treatment Resistant Hypertension

2015 ◽  
Vol 25 (4) ◽  
pp. 495 ◽  
Author(s):  
Brent M. Egan
Keyword(s):  
Resistant Hypertension ◽  
Treatment Options ◽  
Diuretic Therapy ◽  
Clinical Information ◽  
Treatment Resistant ◽  
Antihypertensive Medications ◽  
Optimal Therapy ◽  
Medication Costs ◽  
And Control ◽  
Measurement Artifacts

<p>Treatment resistant hypertension (TRH) is defined by office blood pressure (BP) uncontrolled on ≥3 or controlled on ≥4 antihypertensive medications, preferably at optimal doses and including a diuretic. Apparent (a)TRH is used when optimal therapy, adherence, and measurement artifacts are unknown. Among treated hy­pertensives, ~30% of uncontrolled and 10% of controlled individuals have aTRH, with a higher prevalence in Blacks than other race-ethnicity groups. In ≥50% of aTRH patients, BP measurement artifacts (‘office’ TRH), suboptimal regimens, or suboptimal adher­ence are present, ie, pseudo-resistance. While patients with ‘office’ TRH have fewer cardiovascular events than those with ‘true’ TRH, no evidence confirms that patients with suboptimal regimens or adherence are spared. Averaging several office BPs obtained with an automated monitor can reduce ‘office’ TRH. Home or ambulatory BP monitoring can identify office resistance. Prescribing ≥3 different antihypertensive medication classes, eg, thiazide-type diuret­ic, renin-angiotensin blocker and calcium antagonist at ≥50% of maximum recom­mended doses reasonably defines optimal therapy. Intensifying diuretic therapy, eg, adding an aldosterone antagonist, is effec­tive for many TRH patients who are volume expanded. Clinical information, hemody­namic and renin-guided therapeutics can inform other treatment options. Attention to adverse effects, medication costs, and pill burden can improve adherence and control. Patients with aTRH and suspected second­ary hypertension should be evaluated. Inter­fering substances or medications should be discontinued. These approaches will identify or correct the problem in ~80% of aTRH patients. Referral to a hypertension special­ist and newer therapeutic approaches are options for TRH patients who cannot take or do not respond to optimal therapy. <em>Ethn Dis. </em>2015;25(4):495-498; doi:10.18865/ ed.25.4.495</p>

Resistant hypertension

2018 ◽  
Author(s):  
Iain M. MacIntyre ◽  
David J. Webb
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Resistant Hypertension ◽  
Blood Pressure Monitoring ◽  
Diuretic Therapy ◽  
Antihypertensive Agents ◽  
White Coat Hypertension ◽  
Pressure Monitoring ◽  
Antihypertensive Medications

Resistant hypertension is defined as a blood pressure above target despite adherence to at least three different antihypertensive agents. The term can be used to identify patients with difficult-to-treat hypertension, who might benefit from specialist investigation and/or treatment. It likely affects 10–15% of patients with hypertension. ‘White coat’ hypertension should be excluded first by the use of out-of-office blood pressure monitoring. Risk factors include obesity, older age, chronic kidney disease, and diabetes.Treatment is based on identifying and treating any underlying cause and through the use of multiple antihypertensive medications, in particular ensuring adequate diuretic therapy.

scholarly journals Measuring adherence to therapy in apparent treatment-resistant hypertension: a feasibility study in Irish primary care

2019 ◽  
Vol 69 (686) ◽  
pp. e621-e628 ◽  
Author(s):  
Peter Hayes ◽  
Monica Casey ◽  
Liam G Glynn ◽  
Gerard J Molloy ◽  
Hannah Durand ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Primary Care ◽  
Resistant Hypertension ◽  
Urine Analysis ◽  
Clinical Importance ◽  
Secondary Hypertension ◽  
White Coat Hypertension ◽  
Treatment Resistant ◽  
Antihypertensive Medications ◽  
Adherence To Medication

BackgroundApparent treatment-resistant hypertension (aTRH) is defined as uncontrolled blood pressure (BP) in patients taking three or more antihypertensive medications. Some patients will have true treatment-resistant hypertension, some undiagnosed secondary hypertension, while others have pseudo-resistance. Pseudo-resistance occurs when non-adherence to medication, white-coat hypertension (WCH), lifestyle, and inadequate drug dosing are responsible for the poorly controlled BP.AimTo examine the feasibility of establishing non-adherence to medication, for the first time in primary care, using mass spectrometry urine analysis. Operationalisation would be established by at least 50% of patients participating and 95% of samples being suitable for analysis. Clinical importance would be confirmed by >10% of patients being non-adherent.Design and settingEligible patients with aTRH (n = 453) in 15 university research-affiliated Irish general practices were invited to participate.MethodParticipants underwent mass spectrometry urine analysis to test adherence and ambulatory BP monitoring (ABPM) to examine WCH.ResultsOf the eligible patients invited, 52% (n = 235) participated. All 235 urine samples (100%) were suitable for analysis: 174 (74%) patients were fully adherent, 56 (24%) partially adherent, and five (2%) fully non-adherent to therapy. A total of 206 patients also had ABPM, and in total 92 (45%) were categorised as pseudo-resistant. No significant associations were found between adherence status and patient characteristics or drug class.ConclusionIn patients with aTRH, the authors have established that it is feasible to examine non-adherence to medications using mass spectrometry urine analysis. One in four patients were found to be partially or fully non-adherent. Further research on how to incorporate this approach into individual patient consultations and its associated cost-effectiveness is now appropriate.

New Hope for Resistant Hypertention

2012 ◽  
Vol 5 (1) ◽  
pp. 81-91
Author(s):  
Z Rahman ◽  
KK Karmaker ◽  
M Ahmed ◽  
M Aziz ◽  
S Chowdhury ◽  
...  
Keyword(s):  
Resistant Hypertension ◽  
Patient Adherence ◽  
Public Health Problem ◽  
Drug Regimen ◽  
Renal Sympathetic Denervation ◽  
Major Public Health Problem ◽  
Antihypertensive Medications ◽  
Baroreflex Activation Therapy ◽  
Activation Therapy ◽  
Increasing Trends

Hypertension is a major public health problem. Despite the increasing awareness of hypertension and its implications among patients and treating physicians, the prevalence of resistant hypertension    remains high.Resistant hypertension define as blood pressure that remains elevated above treatment goals despite administration of an optimal three drug regimen that include a diuretic1 The prevalence of resistant    hypertension is projected to increase, owing to the aging population and increasing trends in obesity, sleep apnea, and chronic kidney disease. It is estimated that at least 10% of all patients with hypertension are resistant to existing drugs. Management of resistant hypertension must begin with  a careful evaluation of the patient to confirm the diagnosis and exclude factors associated with “pseudo-resistance,” such as improper BP measurement technique, the white-coat effect, and poor patient adherence to life-style and/or antihypertensive medications. Despite the use of the appropriate dose and type of diuretic to overcome the management of resistant hypertension, we can’t achieve our goal. But there is at least two devices namely Baroreflex Activation Therapy and Catheter-based  renal sympathetic denervation make the new hope for the patient with resistant hypertension DOI: http://dx.doi.org/10.3329/cardio.v5i1.12278 Cardiovasc. j. 2012; 5(1): 81-91

Safety of a Clozapine Trial Following Quetiapine-Induced Leukopenia: A Case Report

2019 ◽  
Vol 14 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Asma H. Almaghrebi
Keyword(s):  
Treatment Options ◽  
Young Female ◽  
Similar Reaction ◽  
Careful Monitoring ◽  
Treatment Resistant ◽  
Blood Cell Count ◽  
Antipsychotic Medications ◽  
Case Presentation ◽  
Clozapine Treatment ◽  
History Of

Background: The clozapine-derivative quetiapine has been shown in some cases to cause leukopenia and neutropenia. Case Presentation: We reported on a case of a young female diagnosed with treatment-resistant schizophrenia. After failed trials of three antipsychotic medications and despite a history of quetiapineinduced leukopenia, clozapine treatment was introduced due to the severity of the patient’s symptoms, the limited effective treatment options, and a lack of guidelines on this issue. Result: Over a ten-week period of clozapine treatment at 700 mg per day, the patient developed agranulocytosis. Her white blood cell count sharply dropped to 1.6 &#215; 10<sup>9</sup> L, and her neutrophils decreased to 0.1 &#215; 10<sup>9</sup> L. There had been no similar reaction to her previous medications (carbamazepine, risperidone, and haloperidol). Conclusion: The safety of clozapine in a patient who has previously experienced leukopenia and neutropenia with quetiapine requires further investigation. Increased attention should be paid to such cases. Careful monitoring and slow titration are advisable.

scholarly journals Role of the Pharmacist in Managing Treatment-Resistant Depression: A Focus on Ketamine

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 118
Author(s):  
Linda Xing Yu Liu ◽  
Marina Golts ◽  
Virginia Fernandes
Keyword(s):  
Current Practice ◽  
Quality Care ◽  
Treatment Options ◽  
Critical Role ◽  
Transitions Of Care ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression ◽  
Multiple Treatments ◽  
The Impact

The impact of depression is well described in the literature, and it is most prominent in patients who have trialed multiple treatments. Treatment-resistant depression (TRD) is particularly debilitating, and it is associated with significant morbidity and mortality. Despite this, there seems to be therapeutic inertia in adopting novel therapies in current practice. Ketamine is an N-methyl-D-aspartate receptor antagonist and anesthetic agent which has recently been shown to be effective in the management of TRD when administered intravenously or intranasally. The treatments, however, are not easily accessible due to restrictions in prescribing and dispensing, high costs, and the slow uptake of evidence-based practice involving ketamine within the Canadian healthcare system. Given the limited treatment options for TRD, novel approaches should be considered and adopted into practice, and facilitated by a multi-disciplinary approach. Pharmacists play a critical role in ensuring access to quality care. This includes dissemination of evidence supporting pharmacological treatments and facilitating translation into current practice. Pharmacists are uniquely positioned to collaborate with prescribers and assess novel treatment options, such as ketamine, address modifiable barriers to treatment, and triage access to medications during transitions of care. Extending the reach of these novel psychiatric treatments in both tertiary and primary care settings creates an emerging role for pharmacists in the collaborative effort to better manage treatment-resistant depression.

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