14 Diagnosing Resistant Hypertension Is a Multistep Process Correctly diagnosing resistant hypertension, whether controlled or uncontrolled, requires the patient to meet all four elements.5-Prevalence of RH To exclude aTRH, confirm that the patient is: 1 On an appropriate antihypertensive drug regimen 2 Truly adherent to the appropriate antihypertensive medications at maximum tolerated dose 3 Measuring BP accurately without white coat effect, with no medications or substances that may increase BP to masquerade as RH 4 Not suffering from an identifiable secondary cause of hypertension or other condition that is not adequately controlled Confirm Adherence Once a clinician has prescribed the appropriate medication regimen at maximum tolerated doses, the first step in diagnosing RH is to confirm medication adherence. Failure to identify and remedy nonadherence contributes to the overestimation of genuine RH. Rates of nonadherence vary widely, from 7% by pharmacy refill records to more than 60% by serum drug levels trials.5-Identifying and Correcting Medication Nonadherence The 2018 AHA Scientific Statement on RH recommends thiazide-like diuretics and mineralocorticoid receptor blockers as part of antihypertensive therapy.5-Specific Therapeutic Regimens and Figure 3 NHANES data suggest that a minority of patients who are taking these two agents and the majority of patients with aTRH are missing one or both medications in their treatment regimen.4-Perspectives A quarter of patients newly started on hypertensive therapy fail to fill their initial prescription. During the first year of treatment, the typical patient has their prescribed antihypertensive medication(s) only 50% of the time, and only 20% of patients have sufficiently high adherence to achieve the antihypertensive results reported in clinical trials.5-Identifying and Correcting Medication Nonadherence
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