Hypertension compliance with

Strict compliance with antihypertensive drug regimen is important in patients witii known hypertension during epoetin tiierapy. 

Do not abruptly discontinue amlodipine compliance with therapy is essential to control hypertension... 

Psychoeducation of the patient and family is required to avoid the development of hopelessness in both the patient and family, and the clinician. Comparing these strategies with other treatments of medical disorders can be useful to help patients and their families understand the medication plan and to improve compliance with and tolerance of treatment. In this instance the example of hypertension is appropriate diuretics may be used alone, or combined with other antihypertensives in different trials, according to response. 

Unfortunately, even perfect compliance with dietary and other restrictions does not guarantee complete protection from MAOI-induced hypertensive crises. There are reports of spontaneous hypertension associated with MAOI therapy. Most of these involved the use of tranylcypromine, but phenelzine also has been implicated. 

Monotherapy of hypertension (treatment with a single drug) is desirable because compliance is likely to be better and cost is lower, and because in some cases adverse effects are fewer. However, most patients with hypertension require two or more drugs, preferably acting by different mechanisms (polypharmacy). According to some estimates, up to 40% of patients may respond inadequately even to two agents and are considered to have "resistant hypertension." Some of these patients have treatable secondary hypertension that has been missed but most do not and three or more drugs are required. 

There were fifty-four subjects whose blood pressures remained elevated despite the use of antihypertensive drugs. Often two or three different drugs are required to completely control hypertension, but such combinations frequently lead to side effects that commonly limit patients compliance with doctors prescriptions. Dr. Paran hoped that the tomato extract would offer an alternative to adding another drug or two. 

Side effects of systemic CsA may include oral ulceration and gingivitis, hypertrichosis, malaise, headaches, muscle cramps, and gastrointestinal disturbance. Serious side effects such as nephrotoxicity and hypertension may be treatment-limiting (32). Prolonged use of cyclosporine and, thus, good patient compliance with the treatment is required in order to adequately control intraocular inflammation. 

Clonidine is administered twice a day for the management of mild to moderate hypertension (6). Transdermal clonidine also has been successfully substituted for oral clonidine in some patients with mild to moderate hypertension whose compliance with a daily dosing regimen may be a problem (28). 

Hyland ME, Kenyon CAP, Allen R, Howarth P. Diary keeping in asthma comparison of written and electronic methods. Br Med J 1993 306 487 89 Kelloway JS, Wyatt RA, Adlis SA. Comparison of patients compliance with prescribed oral and inhaled asthma medications. Arch Intern Med 1994 154 1349-1352. Steiner JF, Fihn SD, Blair B, Inut TS. Appropriate reductions in compliance among well-controlled hypertensive patients. J Clin Epidemiol 1991 44 1361-1371. Chmelik F Doughty A. Objective measurements of compliance in asthma treatment. Ann Allergy 1994 73 527-532. 

In the treatment of chronic diseases, a long term zero order release dosage form is highly desirable as it reduces fluctuations of drug levels, reduces toxicity and increases patient compliance. Problems in the treatment of both hypertension, a lifetime disorder, and opiate addiction are associated with compliance. The goal of this research is to develop a subcutaneously injectable system which can release drug at constant rates over a long period of time. 

In practice, when hypertension does not respond adequately to a regimen of one drug, a second drug from a different class with a different mechanism of action and different pattern of toxicity is added. If the response is still inadequate and compliance is known to be good, a third drug... 

In some chronic diseases in which suppressive drugs will ultimately be needed they may not benefit the patient in the early stages. For example, victims of early parkinsonism or hypertension may be little inconvenienced or hazarded by the disease, as yet, and the premature use of drugs can exact such a price in side-effects that patients prefer the untreated state what patients will tolerate depends on their personality, their attitude to disease, their occupation, mode of life and relationship with their doctor (see Compliance). 

There appears to be a strong link between arterial compliance or stiffness and atherosclerosis and systolic hypertension. In humans, supplementation with soy protein or isoflavones appears to improve com-pliance. In one placebo controlled, randomized, cross-over clinical trial on peri- and postmenopausal women, treatment with 80 mg/day purified soy isoflavones for 5 weeks resulted in improvement of ca. 26% in systemic arterial compliance, even though there was no reduction in blood lipids. Only one study demonstrated a significant decrease in blood pressure, reported in 51 non-hypertensive women after ingestion of 34 mg/day isoflavones,but other studies failed to show a significant effect. ... 

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