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refractory hypertension


The treatment of difficult-to-control hypertension in disadvantaged populations—poor, urban, or ethnically diverse—is a challenge that few individual practitioners or institutions have successfully addressed. This is a public health issue of significant importance, as uncontrolled hypertension leads to increased health care expenditures as well as higher rates of morbidity and mortality. The high prevalence of poor blood pressure control in such populations is multifactorial. Even when barriers such as access to blood pressure screening, primary care, and medications have been overcome, significant numbers of patients have persistently elevated blood pressures despite the use of multiple medications and the best efforts of their primary care physicians. For this group of patients with difficult-to-control blood pressure, we organized a multidisciplinary clinic to examine the reasons for the problem and to devise strategies to successfully address them.

The management of hypertension, like most other chronic diseases, requires careful consideration of patients’ understanding and attitudes regarding diet, personal habits, social supports, health beliefs, and a host of other factors. For approximately 27% of patients, primary care physicians are successful in teaching self-management skills and in controlling their hypertension. Nevertheless, failure to maintain target is common, and up to 18% of hypertensive patients fulfill criteria for difficult-to-control hypertension. For some homogenous populations who are well educated and highly motivated, a more intense, multifac-eted, multidisciplinary approach has been shown to be effective. However, it is uncertain whether such a model would be equally successfully in a very different setting—a public health care system serving an urban, poor, predominantly African American population. canadian antibiotics

In this report, we evaluate our initial experiences with a newly established difficult-to-control blood pressure clinic in an urban, public hospital and describe the reasons for patients’ poorly controlled blood pressure, our treatment strategies, and our successes and failures.

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