Management of Hypertensive Patients With Multiple Drug Intolerances: A Single‐Center Experience of a Novel Treatment Algorithm

Abstract

Multiple drug intolerance to antihypertensive medications (MDI‐HTN) is an overlooked cause of nonadherence. In this study, 55 patients with MDI‐HTN were managed with a novel treatment algorithm utilizing sequentially initiated monotherapies or combinations of maximally tolerated doses of fractional tablet doses, liquid formulations, transdermal preparations, and off‐label tablet medications. A total of 10% of referred patients had MDI‐HTN, resulting in insufficient pharmacotherapy and baseline office blood pressure (OBP) of 178±24/94±15 mm Hg. At baseline, patients were intolerant to 7.6±3.6 antihypertensives; they were receiving 1.4±1.1 medications. After 6 months on the novel MDI‐HTN treatment algorithm, both OBP and home blood pressure (HBP) were significantly reduced, with patients receiving 2.0±1.2 medications. At 12 months, OBP was reduced from baseline by 17±5/9±3 mm Hg (P<.01, P<.05) and HBP was reduced by 11±5/12±3 mm Hg (P<.01 for both) while patients were receiving 1.9±1.1 medications. Application of a stratified medicine approach allowed patients to tolerate increased numbers of medications and achieved significant long‐term lowering of blood pressure.

Diagnosis and management of resistant hypertension

“…When drug intolerance is an issue, a recent study by Antoniou et al 33 demonstrated significantly lower blood pressure at 12-month follow-up (by 17±5/9±3 mm Hg) in patients with multiple antihypertensive drug intolerances through the use of sequentially initiated monotherapies, combinations of maximally tolerated doses or fractional tablet doses, liquid formulations, transdermal preparations and off-label tablet medications (figure 2). This was a small (55 patients), non-randomised trial and while promising, should not be considered definitive evidence.…”

Investigation and management of adult hypertension

“…A small proportion of patients referred to specialist hypertension services have the added complexity of multidrug intolerance to antihypertensives (MDI-HTN) 48. The utilisation of a novel MDI-HTN stepped treatment algorithm (online supplementary box 3) was able to reduce CBP by 17/9 mm Hg and HBP by 11/12 mm Hg over 6 months.…”

A Review on the Role of Chymase in Hypertensive Heart Disease

“…Angiotensin converting enzyme inhibitors were discovered as a result of the evidence pointing towards angiotensin-II in pathogenesis of vascular and cardiac hypertrophy [7]. Discovery of multiple antihypertensive drugs have curtailed most deleterious effects of hypertension but much requires to be done as emerging evidence prove some pitfalls in treatment strategies [13].…”