Items in AFP with MESH term: Patient Compliance

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Can Your Patients Afford the Medications You Prescribe? - Feature


Don't Be a Target for a Malpractice Suit - Feature


Moving Beyond "Noncompliance" - The Last Word


Five Tips for Generating Patient Satisfaction and Compliance - Feature


Evaluation and Management of the Patient with Difficult-to-Control or Resistant Hypertension - Article

ABSTRACT: High blood pressure is often difficult to control. Resistant hypertension is blood pressure above goal despite adherence to a combination of at least three antihypertensive medications of different classes, optimally dosed and usually including a diuretic. The approach to blood pressure that is apparently difficult to control begins with an assessment of the patient's adherence to the management plan, including lifestyle modifications and medications. White-coat hypertension may need to be ruled out. Suboptimal therapy is the most common reason for failure to reach the blood pressure goal. Once-daily fixed-dose combination pills may improve control through the synergism of antihypertensive agents from different classes and improved adherence. Truly drug-resistant hypertension is commonly caused by chronic kidney disease, obstructive sleep apnea, or hyperaldosteronism, all of which can lead to fluid retention. Higher doses of diuretics (or a change to a loop diuretic) are usually needed. Other strategies include adding an alpha blocker, alpha-beta blocker, clonidine, or an aldosterone antagonist (e.g., spironolactone). Particularly in patients with diabetes or renal disease, combining a long-acting nondihydropyridine with a dihydropyridine calcium channel . blocker can also be considered. Obesity, heavy alcohol intake, high levels of dietary sodium, and interfering substances (especially nonsteroidal anti-inflammatory drugs) contribute to hypertension that is resistant or difficult to control.


A Tool for Safely Treating Chronic Pain - Improving Patient Care


Increasing the Success of Antihypertensive Therapy - Editorials


A Hearing Problem - Curbside Consultation


Functional Health Literacy: Improving Health Outcomes - Medicine and Society


When Patients Cannot Afford Their Medications - Curbside Consultation


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