Therapeutic concordance improves blood pressure control in patients with resistant hypertension

Valentina Trimarco, Raffaele Izzo, Pasquale Mone, Maria Lembo, Maria Virginia Manzi, Daniela Pacella, Angela Falco, Paola Gallo, Giovanni Esposito, Carmine Morisco, Gaetano Santulli, Bruno Trimarco

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Introduction: An empathetic approach may be particularly useful in patients with therapy-resistant hypertension (TRH), defined as the failure to achieve target blood pressure (BP) despite a maximal doses of 3 antihypertensive drugs including a diuretic. However, the effects of therapeutic concordance have not been determined in hypertensive patients. Methods: We designed a study to explore the impact of therapeutic concordance in patients with TRH, who were included in an intervention arm based on a protocol in which trained personnel periodically verified the pharmacological regimen of these patients. Results: From a cohort of 5331 hypertensive patients followed-up for 77.64 ± 34.44 months, 886 subjects were found to have TRH; of these, 322 had apparent TRH (aTRH: uncontrolled office BP but optimal home BP) and 285 refused to participate in a second follow-up study, yielding a population of 279 patients with true TRH (tTRH). These tTRH patients were followed according to the therapeutic concordance protocol for 91.91 ± 54.7 months, revealing that 210 patients (75.27%) remained with uncontrolled BP (uncontrolled tTRH, Group I) while 69 patients (24.73%) reached an optimal BP control (average BP <140/90 mmHg in at least 50% of follow-up visits, Group II). Strikingly, at the end of the second follow-up, the percentage of patients displaying a decline in kidney function was significantly smaller in Group II than in Group I (8.5% vs 23.4%, p < 0.012). Conclusions: Taken together, our findings indicate for the first time that therapeutic concordance significantly improves the outcome of antihypertensive treatment in a population of patients with TRH.

Original languageEnglish (US)
Article number106557
JournalPharmacological Research
StatePublished - Jan 2023


  • Adherence
  • Blood pressure
  • Concordance
  • EGFR
  • Hypertension
  • Pharmacologic resistance

ASJC Scopus subject areas

  • Pharmacology


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