When the Going Gets Tough, the Tough Get Going

This satellite symposium took place on 13th June 2015 as  part of the 25th European Meeting on Hypertension and  Cardiovascular Protection in Milan, Italy

Chairperson: Massimo Volpe1
Speakers: Josep Redòn,2 Michel Burnier,3 Massimo Volpe1

1. University of Rome “La Sapienza”, Sant’Andrea Hospital, Rome, Italy
2. Hospital Clinico, University of Valencia, Valencia, Spain
3. Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Disclosure: Massimo Volpe has received advisory board fees from Daiichi Sankyo Europe GmbH and  speaker honoraria from the Menarini Group and Daiichi Sankyo Europe GmbH. Josep Redòn has been a speaker for Menarini International, Daiichi Sankyo, MSD, and Boehringer Ingelheim, and has participated on advisory boards for Daiichi Sankyo. Michel Burnier has received research grants, speaker fees, and consultancy fees from Daiichi Sankyo and the Menarini Group.
Acknowledgements: Writing assistance was provided by Dr Ana Rodríguez de Ledesma, apothecom scopemedical Ltd.
Support: The symposium was organised by the Menarini Group and Daiichi Sankyo Europe GmbH. Authors received honoraria for preparation and delivery of their presentations. The views and opinions expressed  are those of the authors and not necessarily of the Menarini Group and Daiichi Sankyo Europe GmbH.
Citation: EMJ Cardiol. 2015;3(Suppl 4):2-9.

Meeting Summary

Patients with elevated blood pressure (BP) represent a major problem for primary care physicians, not only because of the large number of these patients, but also because BP can prove frustratingly difficult to control in some of them. The management of treatment-resistant hypertension (TRH) is indeed a topic of considerable interest over the last few years, particularly since novel, non-pharmacological interventions held out the prospect of helping these patients. The theme of this mini-symposium was how currently available therapeutic tools can be used to manage ‘difficult-to-control’ patients with persistently elevated BP who may have apparent treatment resistance.

To ensure that this symposium was relevant and practical, invited experts used a patient case in which treatment fails to control BP. One option in such a case might be to assume that the patient has apparent TRH. However, by looking at the case in more detail and carrying out a thorough clinical work-up, other factors such as pseudo-resistance or poor adherence might be playing important roles. The case was used to highlight the importance of investigating the reasons behind a patient’s failure to achieve BP control  and the steps that can be taken to address these issues.

Professor Josep Redòn introduced the clinical case and discussed the selection of appropriate  management strategies and therapies. Estimation of the risk, based on the European Society of  Hypertension (ESH) and the European Society of Cardiology (ESC) treatment guidelines, and details of the ongoing difficulties in reducing the patient’s elevated BP were also covered during his presentation. Professor Michel Burnier discussed in detail difficult-to-control BP and the need for clinical assessment. Among the topics covered were the patient’s referral to a specialist treatment centre, apparent resistance  to modification/intensification of treatment, detailed investigation to rule out spurious resistant  hypertension, assessment of treatment adherence, and development of a plan or management strategy to educate and motivate the patient and improve adherence to treatment. Professor Massimo Volpe discussed the ongoing management of difficult-to-control patients using strategies designed to favour adherence, including single-pill, fixed-dose combination (FDC) therapy. The meeting was concluded with an  interactive discussion, in which the audience raised issues arising from the case presented; these included poor adherence, spurious TRH as a misdiagnosis, and the need for a thorough clinical assessment in order to identify the true cause of the failure to control BP.

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