Adherence to blood pressure-lowering drugs and resistant hypertension: should trial of direct observation therapy be part of preassessment for renal denervation?

Renal denervation (RDN) is increasingly used for resistant hypertension. We report here a case of pseudoresistance of hypertension caused by nonadherence to prescribed drug therapy (6 medications), which evaded detection by verification of prescription filling. Direct observation therapy (DOT), in which usual antihypertensive medications are given under supervision, produced substantial reductions in blood pressure, which was subsequently controlled chronically with 3 antihypertensive agents, confirming pseudoresistant hypertension. The novel teaching points are that evaluation of nonadherence to drug therapy is a crucial component in diagnosing resistant hypertension before RDN and that DOT may be extremely useful in avoiding an unnecessary and costly procedure.