Algorithm Attempts To Overcome Medical Intolerance In Hypertensive Patients

Dr M Lobo PhD FRCP Director Barts BP Centre of Excellence Consultant Physician and Hon Senior Lecturer NIHR Barts Cardiovascular Biomedical Research Unit William Harvey Research Institute, London Interview with:
Dr M Lobo PhD FRCP

Director Barts BP Centre of Excellence
Consultant Physician and Hon Senior Lecturer
NIHR Barts Cardiovascular Biomedical Research Unit
William Harvey Research Institute, London

Medical Research: What hypothesis did you set out to investigate and why?

Dr. Lobo: We investigated the clinical utility of a novel treatment algorithm for multi-drug intolerant patients with hypertension who are at very high risk of cardiovascular disease due to uncontrolled blood pressure and inability to take conventional (guideline-based) antihypertensive regiments. These patients are often poorly managed by primary care physicians (or specialists such as cardiologists) because there has been little interest/research in medication intolerance. There has however been a major focus on drug non-adherence as a cause of failure to control hypertension – we believe that a key cause of non-adherence is medication intolerance which patients do not always volunteer.

Medical Research: What is the report’s ultimate take-away message?

Dr. Lobo: Our novel stepwise algorithm was successful in managing uncontrolled hypertension in the majority of patients without needing an increase in their medicines burden. The message therefore is that patients who do not tolerate their antihypertensives do not have to put up with side effects and resultant poor quality of life as we have demonstrated that there are ways to get around medication intolerances.

Medical Research: Did any findings surprise you?

Dr. Lobo: Not from the study itself – but it was surprising to hear from patients how difficult it is to communicate issues around medicines intolerance to their carers, particularly those relating to bizarre/pharmacologically unpredictable side effects which clinicians either disbelieve or ignore. As a result some patients have felt suicidal with their drug side effects and have held exceedingly negative beliefs about their carers. After all it is not helpful to tell patients they must take their antihypertensive tablets or have a stroke when the tablets are causing enormous difficulty due to side effects. Whether these side effects are pharmacologically explainable or not is of no relevance.

Medical Research: What future research is recommended?

Dr. Lobo: This is an under researched area and is important because we started with the assumption that what our patients report is correct and believable and therefore alternatives strategies to get BP under control were needed. Future research should aim to quantify causes of failed adherence in long term conditions and to chat extent medication intolerance plays a role

More clinical trials are needed of strategies to manage medication intolerances and these could include our treatment algorithm or device-based approaches to treatment of hypertension.

Given that medication intolerance is highly prevalent in long term conditions it behoves carers to be aware of means to manage this. Importantly we should also be actively questioning our patients for drug side effects rather than assuming they are taking the tablets because they often claim adherence to satisfy/please their care givers.

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Sotiris Antoniou, Manish Saxena, Nadya Hamedi, Catherine de Cates, Sakib Moghul, Satnam Lidder, Vikas Kapil, Melvin D. Lobo. Management of Hypertensive Patients With Multiple Drug Intolerances: A Single-Center Experience of a Novel Treatment Algorithm. The Journal of Clinical Hypertension, 2015; DOI: 10.1111/jch.12637 is not a forum for the exchange of personal medical information, advice or the promotion of self-destructive behavior (e.g., eating disorders, suicide). While you may freely discuss your troubles, you should not look to the Website for information or advice on such topics. Instead, we recommend that you talk in person with a trusted medical professional.

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