Managing Resistant Hypertension: Unpacking Adherence and Polypharmacy

Managing patients on multiple antihypertensive medications presents significant practical challenges that extend beyond simple pharmacological considerations. Dr Cohen acknowledges the complexity of maintaining adherence to 3 or more daily medications while managing other life responsibilities including work obligations, family care, and additional health conditions. Health care providers must understand each patient’s daily routine and life circumstances to develop realistic medication schedules that fit within their existing lifestyle constraints and responsibilities.

The challenge of polypharmacy in resistant hypertension requires health care providers to move beyond simple medication prescribing to become lifestyle coaches and adherence specialists. Successful treatment demands understanding of individual patient circumstances, family dynamics, and social support systems that influence medication compliance. Providers must help patients integrate complex treatment regimens into their daily routines while addressing practical barriers such as work schedules, childcare responsibilities, and financial constraints that may impact treatment success.

Patient counseling and education become increasingly critical as treatment complexity increases with fourth- and fifth-line therapies. Health care providers must engage patients in forward-thinking discussions about long-term cardiovascular consequences of uncontrolled hypertension, helping them understand that current treatment challenges are investments in future health outcomes. This approach requires moving beyond immediate symptom management to help patients visualize their health trajectory and maintain motivation for complex treatment regimens that may not provide immediate symptomatic relief.