title: Managing the patient with hard-to-control hypertension.
abstract: Less than 25 percent of patients with hypertension in the United States have their blood pressure under control, mainly because of inadequate or inappropriate therapy and noncompliance. Approximately one half of these treatment failures are related to factors such as cost and adverse effects of medication, complex drug regimens, failure of clinicians to fully realize the benefits of antihypertensive therapy and lack of patient education. Other major causes of unresponsiveness to antihypertensive therapy include "white coat" hypertension, pseudohypertension, obesity, volume overload, excess alcohol intake and sleep apnea, as well as inappropriate antihypertensive drugs and drug combinations, and unfavorable interactions with prescription and other drugs. In many patients, these factors must be dealt with before blood pressure can be controlled.
authors.affiliation: Division of Cardiovascular Disease, University of Alabama School of Medicine, Birmingham, USA. soparil@uab.edu
authors.forename: S
authors.initials: S
authors.lastname: Oparil
authors.forename: D A
authors.initials: DA
authors.lastname: Calhoun
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004338:Drug Combinations; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D010349:Patient Compliance; D010353:Patient Education as Topic; D012307:Risk Factors; D013664:Teaching Materials
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations