Lab Monitoring or Follow-Up Strategies With New Agents

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Resistant hypertension management requires strategic follow-up scheduling with most patients seen within 4 to 6 weeks after medication changes. The A-TIME study demonstrated that 2-week intervals are too frequent, leading to excessive changes and reduced adherence, while 3-month intervals are inadequate for optimal control. High-risk patients, particularly those with elevated potassium levels or kidney disease, may require laboratory monitoring within 1 to 2 weeks when starting medications affecting electrolyte balance.

Home blood pressure monitoring represents a cornerstone of resistant hypertension management, providing more accurate assessment than office readings affected by white coat effects. Proper cuff sizing and patient education are essential for reliable home monitoring data. Remote patient monitoring technologies and team-based care approaches, including clinical pharmacists and physician extenders, help overcome access barriers and therapeutic inertia that commonly plague resistant hypertension management.

Successful resistant hypertension management requires systematic approaches to prevent patient loss to follow-up, which contributes significantly to treatment resistance. Health care teams must implement systems to identify and reengage patients who miss appointments, as prescription persistence requires multiple successful interactions over years. Virtual care options have expanded access for patients with transportation or mobility barriers, though individual patient preferences for in-person versus virtual visits should guide delivery methods.