Open AccessManagement of Hypertensive Patients With Multiple Drug Intolerances: A Single‐Center Experience of a Novel Treatment Algorithm
Author(s) -
Antoniou Sotiris,
Saxena Manish,
Hamedi Nadya,
Cates Catherine,
Moghul Sakib,
Lidder Satnam,
Kapil Vikas,
Lobo Melvin D.
Publication year - 2016
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.12637
Subject(s) - medicine , blood pressure , drug , single center , pharmacotherapy , antihypertensive drug , algorithm , pharmacology , computer science
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.