title: Management of Hypertensive Patients With Multiple Drug Intolerances: A Single-Center Experience of a Novel Treatment Algorithm.
abstract: Multiple drug intolerance to antihypertensive medications (MDI-HTN) is an overlooked cause of nonadherence. In this study, 55 patients with MDI-HTN were managed with a novel treatment algorithm utilizing sequentially initiated monotherapies or combinations of maximally tolerated doses of fractional tablet doses, liquid formulations, transdermal preparations, and off-label tablet medications. A total of 10% of referred patients had MDI-HTN, resulting in insufficient pharmacotherapy and baseline office blood pressure (OBP) of 178±24/94±15 mm Hg. At baseline, patients were intolerant to 7.6±3.6 antihypertensives; they were receiving 1.4±1.1 medications. After 6 months on the novel MDI-HTN treatment algorithm, both OBP and home blood pressure (HBP) were significantly reduced, with patients receiving 2.0±1.2 medications. At 12 months, OBP was reduced from baseline by 17±5/9±3 mm Hg (P<.01, P<.05) and HBP was reduced by 11±5/12±3 mm Hg (P<.01 for both) while patients were receiving 1.9±1.1 medications. Application of a stratified medicine approach allowed patients to tolerate increased numbers of medications and achieved significant long-term lowering of blood pressure.
authors: Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK.|Department of Pharmacy, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors: Sotiris
authors: S
authors: Antoniou
authors: Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK.|William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.
authors: Manish
authors: M
authors: Saxena
authors: Department of Pharmacy, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors: Nadya
authors: N
authors: Hamedi
authors: Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors: Catherine
authors: C
authors: de Cates
authors: Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors: Sakib
authors: S
authors: Moghul
authors: Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors: Satnam
authors: S
authors: Lidder
authors: Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK.|William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.
authors: Vikas
authors: V
authors: Kapil
authors: Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK.|William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.
authors: Melvin D
authors: http://orcid.org/0000-0002-1122-948X
authors: MD
authors: Lobo
mesh_terms: D000328:Adult; D000465:Algorithms; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D016903:Drug Monitoring / Q000379:methods; D004351:Drug Resistance; D004359:Drug Therapy, Combination / Q000379:methods / Q000523:psychology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D008131:London; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D054539:Medication Therapy Management; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents