Shared Decision-Making With Patients Who Have Failed Multiple Agents

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Effective resistant hypertension management requires robust shared decision-making processes, particularly for patients frustrated by multiple treatment failures. Clinicians must help patients understand the explanatory model linking blood pressure control to cardiovascular risk reduction, moving beyond pill-taking compliance to genuine health outcome focus. Many apparent treatment resistance cases actually reflect medication fears or concerns rather than true pharmacological resistance.

Patient adherence often suffers from preconceived notions about specific medication classes based on personal experiences or anecdotal reports. New therapeutic options like endothelin receptor antagonists provide “clean slate” opportunities without patient preconceptions, while renal denervation offers alternatives for medication-averse patients. Clinicians should explore patient concerns systematically and provide balanced information about both treatment benefits and consequences of uncontrolled hypertension.

Modern patients frequently consult online resources, including “Dr Google” and AI platforms, requiring clinicians to address misinformation proactively. Health care providers must balance acknowledging potential medication adverse effects while emphasizing the greater long-term risks of uncontrolled hypertension. Effective communication involves explaining how short-term medication concerns pale compared with long-term cardiovascular consequences, using patient-friendly language and incorporating diabetes educators or other health care team members when appropriate.