title: Apparent treatment-resistant hypertension - patient-physician relationship and ethical issues.
abstract: BACKGROUND
  Poor drug adherence is a major cause of apparent treatment-resistant hypertension. As a consequence, several methods have been developed and attempted implemented in clinical practice to reveal non-adherence and to monitor drug adherence. There are, however, several hitherto unresolved ethical aspects regarding potential methods for drug monitoring in these patients.
  
  
  RESULTS
  The most striking challenge is the balance between patient autonomy and the physician's desire for the patient to adhere to the prescribed therapy. Also, methods for monitoring must only be implemented in the treatment of well-informed and consenting patients. Major resources are used on non-adherent patients; how long the physician should encourage continuation of treatment is an important question.
  
  
  CONCLUSIONS
  We believe that physicians should reflect and discuss these potential challenges, and that patient education, information and a solid patient-physician relationship are essential for achieving drug adherence. Methods for monitoring adherence represent, however, a useful and often necessary supplement.
authors.affiliation: a Faculty of Medicine , University of Oslo , Oslo , Norway.
authors.forename: Julian E
authors.initials: JE
authors.lastname: Mariampillai
authors.affiliation: a Faculty of Medicine , University of Oslo , Oslo , Norway.
authors.forename: Per Anders
authors.initials: PA
authors.lastname: Eskås
authors.affiliation: a Faculty of Medicine , University of Oslo , Oslo , Norway.
authors.forename: Sondre
authors.initials: S
authors.lastname: Heimark
authors.affiliation: b Department of Medical Biochemistry , Oslo University Hospital, Ullevaal , Oslo , Norway.|c Section of Cardiovascular and Renal Research , Oslo University Hospital, Ullevaal , Oslo , Norway.
authors.forename: Anne Cecilie K
authors.initials: AC
authors.lastname: Larstorp
authors.affiliation: a Faculty of Medicine , University of Oslo , Oslo , Norway.|c Section of Cardiovascular and Renal Research , Oslo University Hospital, Ullevaal , Oslo , Norway.|d Department of Cardiology , Oslo University Hospital, Ullevaal , Oslo , Norway.|e Department of Internal Medicine , Oslo University Hospital, Ullevaal , Oslo , Norway.
authors.forename: Fadl Elmula M
authors.initials: FE
authors.lastname: Fadl Elmula
authors.affiliation: a Faculty of Medicine , University of Oslo , Oslo , Norway.|c Section of Cardiovascular and Renal Research , Oslo University Hospital, Ullevaal , Oslo , Norway.|f Department of Nephrology , Oslo University Hospital, Ullevaal , Oslo , Norway.
authors.forename: Aud
authors.initials: A
authors.lastname: Høieggen
authors.affiliation: a Faculty of Medicine , University of Oslo , Oslo , Norway.|g Center for Medical Ethics, University of Oslo , Oslo , Norway.
authors.forename: Per
authors.initials: P
authors.lastname: Nortvedt
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D016903:Drug Monitoring / Q000523:psychology; D004351:Drug Resistance; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology*; D007258:Informed Consent; D010349:Patient Compliance / Q000523:psychology*; D063046:Patient Medication Knowledge; D010358:Patient Participation / Q000523:psychology; D010361:Patients / Q000523:psychology; D010817:Physician-Patient Relations / Q000941:ethics*; D010820:Physicians / Q000523:psychology
chemical_list: D000959:Antihypertensive Agents
keywords: Ethical aspects; blood pressure-lowering treatment; drug adherence; treatment-resistant hypertension