摘要：

suggest that up to 40% of newly diagnosed hypertensive patients will discontinue their antihypertensive medications during the first year, with only 40% of the remaining patients continuing their therapy over the next decade (25-27). An evaluation of 4,783 hypertensive patients en- rolled in phase IV clinical studies, with follow-up ranging from 30 to 330 days, demonstrated a discontinuation rate of antihypertensive drug of Ϸ50% within 1 year (28). More- over, there was an inverse relationship between the likeli- hood of early treatment discontinuation and the frequency of the daily dosing regimen. Factors that improve medica- tion adherence include the following: 1) selection of agents with low side effect profiles such as blockers of the renin- angiotensin system (RAS); 2) avoidance of complicated dosing schedules so that once-daily agents either alone or in fixed dose would be preferred; 3) use of pill boxes or family to help patients with memory deficits or psychiatric disor- ders; and 4) improved communication between the patient and physician to ensure that the patient understands the regimen and why the medication should be taken in the way prescribed. Failing to educate the patient about the impor- tance of achieving BP goals, the predicted side effects of the agents, and the cost of medication are the most common reasons for drug discontinuation (29,30).A relatively surprising cause of pseudo-resistant hyper- tension is suboptimal dosing of antihypertensive agents or inappropriate combinations of agents. Data from a clinical hypertension specialty clinic demonstrated that either in- creasing the dose or initiating or switching to the proper diuretic was the most common change that achieved BP goal among patient referred for resistant hypertension (31). An important culprit that contributes to the genesis of pseudo-resistant hypertension is clinical inertia, defined as the conscious decision by a clinician to not adequately treat a condition despite knowing that it is present (32). Despite efforts to translate evidence-based guidelines into clear recommendations for clinical practice (11), many physicians are reluctant to adhere to these guidelines (16). Clinical

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