Abstract
Most studies on the prevalence and determinants of resistant hypertension (RH) do not account for white coat hypertension,
medication non-adherence, or use of suboptimal treatment dosages. We studied the characteristics, drug combinations, and
dosages of patients on at least three antihypertensives of different classes who had uncontrolled blood pressure on 24-hour
ambulatory blood pressure monitoring and high medication adherence measured by electronic monitoring. The data were
collected as part of the baseline measures of a hypertension control trial. Of 140 monitored primary care patients, all
with uncontrolled office blood pressure, 69 (49%) were on at least three antihypertensives of different classes. Of these
69, 15 (22%) were controlled on ambulatory blood pressure monitoring, 20 (29%) were uncontrolled and non-adherent,
leaving only 34 (49%) adherent to their medications and having uncontrolled ambulatory hypertension (uncontrolled RH).
Thirty-one (91%) of the 34 uncontrolled RH patients were prescribed a diuretic, of which 24 were on hydrochlorothiazide
25 mg. Less than half of the patients on angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or calcium
channel blocker were prescribed maximal doses of these agents. Half of the RH can be attributed to white coat effect and poor
medication adherence, and all of the remaining patients were on apparently suboptimal drug combinations and/or dosages.
Primary care physicians need to be educated regarding the optimal treatment of RH. J Am Soc Hypertens 2013;7(6):471–476.