[Resistant hypertension despite nine different antihypertensive drugs?].
BACKGROUND
Treatment-resistant hypertension is a common problem in an outpatient setting and often results in hospital admission. Non-identified secondary hypertension, hypertensive nephrosclerosis and non-compliance are major reasons for treatment resistance.


METHODS
A 75-year old woman was admitted to the emergency room because of a hypertensive crisis with alleged treatment-resistant hypertension and progressive headache. Two months ago, renal artery stenosis had been ruled out and a diagnosis of hypertensive cardiomyopathy was established. On admission, the patient had a blood pressure of 210/100 mmHg despite an antihypertensive treatment with nine different drugs. Further investigations ruled out secondary hypertension due to an endocrine cause but were consistent with hypertensive nephrosclerosis. With a supervised drug intake the blood pressure was rather normal to hypotensive, resulting in the need for significant reduction of the antihypertensive medication. The apparent discrepancies were discussed in detail with the patient who finally admitted a previous inconsistent intake of the antihypertensive drugs. Following thorough training and education on the purpose of continued antihypertensive therapy, the patient could be discharged with a normotensive blood pressure profile.


CONCLUSIONS
Therapy of treatment-resistant hypertension should always consider non-compliance and secondary hypertension as possible reason.
Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Lübeck, Germany.
Philip M
PM
Muck
Jürgen
J
Steinhoff
Hendrik
H
Lehnert
Christian S
CS
Haas
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003937:Diagnosis, Differential; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D006974:Hypertension, Malignant / Q000188:drug therapy* / Q000209:etiology; D055118:Medication Adherence; D010353:Patient Education as Topic
D000959:Antihypertensive Agents
Hypertension. 2004 Nov;44(5):595-601
15452024
Thyroid. 2007 Nov;17(11):1067-73
18047429
Am Fam Physician. 2003 Jan 1;67(1):67-74
12537168
Praxis (Bern 1994). 2007 Oct 10;96(41):1587-91
17987929
Curr Hypertens Rep. 2010 Aug;12(4):220-5
20532698
Blood Press Suppl. 2005 Dec;2:42-5
16429642
J Coll Physicians Surg Pak. 2006 Jan;16(1):23-6
16441983
Expert Opin Pharmacother. 2008 Jun;9(8):1271-7
18473702
Int J Cardiol. 2008 Feb 20;124(1):6-21
17462751
Am J Ther. 2008 Jul-Aug;15(4):351-5
18645339
Ugeskr Laeger. 2009 Jun 15;171(25):2109-13
19671393