Detection and management of a case of drug-resistant hypertension

Résumé

Community pharmacies, with more patient interaction than primary care physicians (PCP), are well-positioned to detect medication-related problems (DRP). The case of José, 82, diagnosed with hypertension in 2002, highlights the collaborative role of pharmacists. Despite regular antihypertensive treatment, José’s blood pressure rose, prompting a thorough assessment of his medication history. A self-measurement of blood pressure (SMBP) revealed consistently high readings, leading to suspicion of primary hyperaldosteronism. Referral to the PCP was accompanied by a detailed referral letter, justifying the suspicion and recommending specific diagnostic tests. José experienced hypotension during a summer holiday, further substantiating the suspicion. Diagnostic tests, including an MRI, revealed a 2mm aldosterone-producing adenoma. While awaiting surgery, José maintained his antihypertensive therapy, with post-surgery evaluation planned. The case underscores the pharmacist’s crucial role in screening for resistant hypertension, collaborative care, and considering multiple factors in diagnostic decisions.