Therapy resistant hypertension -: significance of electronic compliance monitoring

History and clinical findings: A 71-year-old woman was admitted with arterial hypertension resistant to drug therapy (office readings 197/82 mmHg) under medication with P-blocker, AT(1)-antagonist and a diuretic. The only physical pathologic finding was an adipositas. Diagnosis, treatment and course: The patient was suffering from isolated systolic hypertension, grade 3 corresponding to WHO-guidelines. Despite antihypertensive triple therapy office as well as self-measured blood pressure values (mean 170/82 mmHg) remained elevated. Thus, the patient fulfilled the criteria of a resistant hypertension. The degree of compliance was only 50%, detected by using a Medication-Event-Monitoring-System,(correct dosing interval 17.1%). We discussed the results of compliance- and blood pressure self-measurement with the patient. In the following period of compliance- and blood pressure self-measurement (with unchanged anti hypertensive therapy) the compliance increased dramatically with a degree of 90.9% and self-measured blood pressure values almost normalized (mean 137/71 mmHg). Conclusion: The control of compliance by using electronic compliance-monitoring may help to discover non-compliance as a frequent cause of resistant hypertension and to avoid unnecessary cost-extensive procedures.