Non-compliance not a reason for treatment-resistant
hypertension
There is no difference in compliance with drug treatment
in patients with treatment-resistant hypertension and in patients with
treatment-responsive hypertension, say Swiss researchers.
Dr Reto Nuesch and colleagues, of the University
Hospital, Basle, conducted a study to assess the contribution of non-compliance
to treatment-resistant hypertension.
Patients were eligible for inclusion in the study
if they had primary hypertension and had been following a stable treatment
regimen of between two and four drugs for at least a month. The researchers
measured patients’ blood pressure in the clinic and also by using validated
ambulatory devices. These measurements were repeated at the end of the
study after the patient’s compliance with their treatment had been assessed.
The researchers assessed patients’ compliance with
treatment using a medical event monitoring system (MEMS) over four weeks.
The mean percentage of prescribed doses removed from the MEMS device was
calculated and patients who removed 80 per cent or more of their doses
were considered to be compliant (n=86). Fewer patients were considered
to be non-compliant (n=17).
Out of the 49 non-responsive patients, 40 were compliant
with their treatment, compared with 46 out of the 54 responsive patients.
This, say the researchers, shows that there was no difference between
the two groups in terms of compliance: “Our data suggest that poor compliance
with antihypertensive treatment was not more prevalent in treatment-resistant
patients than in treatment-responsive patients.”
The researchers note that there was no change in
ambulatory blood pressure between the start and end of the study but say
that they cannot exclude the possibility that monitoring with the MEMS
device improved compliance without improving blood pressure control.
They conclude: “We were unable to confirm the common
assumption that non-compliance with treatment is substantially more prevalent
in patients not responsive to antihypertensive drugs.” (BMJ 2001;323:
142.)
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