P0153IS THERE ANY VALUE FOR HOSPITALIZATION FOR CHECKING MEDICATION ADHERENCE DUE TO RESISTANT AND REFRACTORY HYPERTENSION SUSPICIOUS? IMPLICATIONS FOR MID-TERM FOR BLOOD PRESSURE CONTROL
Authors: Pio de Abreu Andrea , Trani Fernanda , Vieira Giovanio , Aparecido Bortolotto Luiz , Ferreira Drager Luciano 
Published: June 2020

Abstract

Background and Aims
Resistant hypertension (RH) and refractory hypertension (RefH, an extreme phenotype of RH) are associated with increased cardiovascular events and target-organ damage. However, appropriate RH and RefH diagnosis require good drug adherence. In this context, the “gold standard” method for assessing adherence is supervised medication intake. However, it is not clear the real utility of supervised medication intake during a hospital stay. Therefore, this study was aimed to evaluate whether hospitalization for confirming antihypertensive adherence in patients with RH and RefH may impact blood pressure (BP) values and BP control after hospital discharge in patients with RH or RefH suspicious at a tertiary outpatient clinic.

Method
From June 2015 to June 2017, we recruited consecutive patients with RH or RefH suspicious admitted to the Hospital for confirming treatment adherence and the respective diagnosis. We excluded patients with secondary forms of hypertension. RH was defined as uncontrolled office BP (≥140 and/or ≥90mmHg) despite using ≥3 classes at optimal doses (one of them being diuretic) or controlled BP using ≥4 classes. RefH was defined as no BP control despite using ≥5 antihypertensive drugs. During hospitalization, all patients used low sodium diet (∼3grs of salt/day) and had supervised taking of prescribed drugs by the medical team aiming BP control. We defined not only the rate of adherence and RH/RefH status but also BP and number of antihypertensive drugs at hospital discharge and in the two first outpatients visits returns.

Results
We studied a total of 83 patients with suspected RH/RefH (age 53±14 years; 76% female gender; body mass index 28.8±6.2 Kg/m2; pre-hospitalization systolic 177±28mmHg and diastolic BP 106±21mmHg). Of these, 68.7% (57 patients) had suspected RefH in the outpatient clinic. The average number of antihypertensive drugs on admission was 5.3±1.3 classes. After hospitalization, the overall frequency of RH fell to 80% (66 patients). The average number of antihypertensive drugs at hospital discharge as well as systolic and diastolic BP was 4.5±1.3 classes, 131±17mmHg and 80±12mmHg, respectively (p&lt;0.001 vs. pre-hospitalization for all comparisons). Among the RH types, RefH was confirmed in only 27 patients (32.5%). As compared to pre-hospitalization data, we noticed consistent lower number of antihypertensive drugs and lower levels of systolic and diastolic BP both at first outpatient visit post-discharge (mean returned time 2.1±1.7 months) and second outpatient visit post-discharge (mean returned time 7.1±2.6 months): First visit: 4.3±1.2 classes, systolic BP: 152±24 mmHg, diastolic BP: 89±17 mmHg; second visit: 4.5±1.3 classes, systolic BP: 150±26 mmHg, diastolic BP: 89±15 mmHg; (p&lt;0.001 vs. pre-hospitalization for all comparisons). As a consequence, the rate of patients that reached at least 140x90mmHg increased from 0% to 35% (first visit post-discharge) and 38.5% (second visit post-discharge).

Conclusion
Supervised medication intake with controlled salt diet during hospitalization may help not only to define the RH and RefH status in uncontrolled hypertensive outpatients but also to have impact on the number of antihypertensive drugs and lower BP values in the mid-term follow-up.