Barriers in the Treatment Landscape of Resistant Hypertension

Challenges in Management

Despite the availability of numerous effective and relatively affordable pharmacologic agents for hypertension, patient compliance remains the primary obstacle to blood pressure control. Even with three, four, or five prescribed medications, uncontrolled blood pressure will persist if patients don't take them regularly. The challenge lies in convincing patients to incorporate these medications into their daily routine, similar to how they might remember vitamins.

Healthcare provider behavior presents another challenge in hypertension management. Clinical inertia or physician inertia occurs when practitioners are slow to respond to uncontrolled blood pressure, often finding excuses such as stress, white coat hypertension, dietary factors, or other issues instead of appropriately increasing medication dosages.

Medication side effects present significant challenges, particularly when patients require three or four different drugs. Blood pressure medications can affect electrolyte levels, causing low sodium, low potassium, or high potassium, and may impact kidney function. Managing these side effects while finding the optimal treatment solution adds complexity to resistant hypertension care.