Abstract 074: Non-Adherence to Prescribed Blood Pressure Lowering Drugs in Patients With Suspected “Resistant” Hypertension: A Call for Rigorous Adherence Testing
Bibliographic record
Abstract
Background: Pseudoresistance from non-adherence to blood pressure (BP) lowering drugs can cause unnecessary medical visits and invasive diagnostic tests and procedures. It also leaves patients at a high risk for vascular outcomes. There is currently no unified approach to the diagnosis of non-adherence. Direct questioning by medical personnel and review of pharmacy filling do not reveal the full extent of non-adherence. Direct observational therapy (DOT), a test where a patient’s BP response is monitored after supervised administration of BP lowering drugs, has never been prospectively evaluated for diagnosis of suspected resistant hypertension (HTN). Methods: We conducted a prospective study to estimate the prevalence of pseudoresistant HTN using the DOT test. Eligible patients were adults with suspected resistant HTN, defined as daytime average systolic blood pressure (SBP) >135 mmHg on 24-hour ambulatory blood pressure monitoring (ABPM) while on 3 or more BP lowering drugs. Patients confirmed adherence at the clinic, and they had their pharmacy records reviewed. For the DOT, prescribed BP lowering drugs were administered by a nurse at the HTN clinic. BP response was monitored at the office until peak BP effect was reached followed by immediate 24-hour BP ambulatory monitoring, which was repeated at 1 month. Results: 60 patients were enrolled, and 50 patients completed this study. 30 patients had confirmed resistant HTN. 20 patients had a large SBP decrease during observation immediately post drug administration ( ≥ 20 mmHg) as well as daytime average SBP on 24-hour ABPM (>10 mmHg) as compared to their baseline SBPs. Of these 20 patients, 15 continued to have controlled BP at the 24-hour ABPM done at 1 month post DOT, indicating medium term change in in adherence. Conclusions: A large proportion of patients with suspected resistant HTN have pseudoresistant HTN from non-adherence. The diagnosis of pseudoresistance was associated with subsequent cure of resistant HTN in 75% of cases. Proper assessment of adherence is essential to avoid unnecessary drug escalation, and/or investigations for secondary HTN. The DOT represents a simple test for diagnosis and management of suspected resistant HTN, with important ramifications for health care policy makers.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".