Background The prevalence of medication non-adherence in the setting of resistant hypertension varies from 5 to 80% in the published literature. The aim of this systematic review was to establish the overall prevalence of non-adherence and evaluate the effect of the method of assessment on this estimate. Methods MEDLINE, EMBASE, Cochrane, CINAHL, and Web of Science (database inception to Nov 2020) were searched for relevant articles. We included studies including adults with a diagnosis of resistant hypertension, with some measure of adherence. Details about the method of adherence assessment were independently extracted by two reviewers. Pooled analysis was performed using the random effects model and heterogeneity was explored with metaregression and subgroup analyses. The main outcome measured was the pooled prevalence of non-adherence and the prevalence using direct and indirect methods of assessment. Results 42 studies comprising 71353 patients were included. The pooled prevalence of non-adherence was 37% (95% confidence interval 27 to 47 %) and lower for indirect methods (20%, 95% CI 11 to 35 %), than for direct methods (46%, 95% CI 40 to 52 %). Metaregression suggested study level younger age, and recent publication year as potential factors contributing to the heterogeneity. Conclusions Indirect methods (pill counts or questionnaires) are insufficient for diagnosis of non-adherence, and report less than half the rates as direct methods (direct observed therapy or urine assays). The overall prevalence of non-adherence in apparent treatment resistant hypertension is extremely high, and necessitates a thorough evaluation of non-adherence in this setting.

The photosensitization of the cereal pathogen Fusarium culmorum by phenylheptatriyne (PHT), a naturally occurring acetylene of Bidens pilosa L. (Asteraceae), was investigated. PHT strongly inhibited germination of macroconidia (mean effective concentration (EC50) = 1.7 ppm) and growth of mycelia (EC50 = 5.6 ppm) of F. culmorum in the presence of near-ultraviolet radiation. Photosensitization of macroconidia was found to be fungicidal and was not reversed after repeated washings in PHT-free media. Photosensitization was less apparent in germ tube elongation in liquid media. However, nonphotosensitizing growth inhibition was observed in these trials. Endogenous levels of PHT in Bidens pilosa were highest (up to 450 μg/g fresh weight) in all plant parts during the seedling stage and declined during vegetative growth. The concept that PHT acts as a preinfectional inhibitor to F. culmorum is discussed.

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Resistant hypertension is common and known to be a risk factor for cardiovascular events, including stroke, myocardial infarction, heart failure, and cardiovascular mortality, as well as adverse renal events, including chronic kidney disease and end-stage kidney disease. This review will discuss the definition of resistant hypertension as well as the most recent evidence regarding its diagnosis, evaluation, and management. The issue of medication non-adherence and its association with apparent treatment-resistant hypertension will be addressed. Non-pharmacological interventions for the treatment of resistant hypertension will be reviewed. Particular emphasis will be placed on pharmacological interventions, highlighting the role of mineralocorticoid receptor antagonists and sodium-glucose cotransporter-2 inhibitors and device therapy, including renal denervation, baroreceptor activation or modulation, and central arteriovenous fistula creation.

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