Background The management of hypertension in patients with known multiple drug intolerance (MDI) is a fundamental challenge. Our hypertension specialist centre has devised an alternative protocol to standard dosing for patients referred with MDI. This includes use of fractional tablet dosing, liquid formulations and trans-dermal formulations of standard anti-hypertensive (s).

Purpose To assess the effects of an innovative approach to blood pressure (BP) control in patients with known MDI.

Material and methods We retrospectively analysed clinic letters for the first 25 patients with a diagnosis of MDI who had at least 3 clinic visits. Clinic BP and any modification to treatment were extracted. A change in clinic BP from baseline through subsequent visits was analysed. Data are expressed as mean ± Standard deviation.

Results 25 (15 female) patients (mean age 62.1 ± 12.0 years) were intolerant of 6.3 ± 3.6 anti-hypertensive medicines at the first visit with baseline clinic BP of 170 ± 21/98 ± 15 mmHg. Patients had 4.6 ± 1.5 follow-up visits over 1.2 ± 1.0 yrs. Clinic systolic/diastolic BP (SBP/DBP) were reduced compared to baseline over the period of follow-up (p < 0.001, p = 0.05 respectively, table 1).

Conclusion Fractional tablet dosing may target multiple physiological pathways but minimise dose-dependent adverse effects. Liquid formulations avoid excipients that may contribute to adverse effects and trans-dermal patches overcome gastro-intestinal intolerance associated with tablets. This is the first dedicated anti-hypertensive protocol for high-risk patients with multiple medicines intolerance and application of our novel strategy. It demonstrated BP control improving consistently over subsequent visits.

References and/or Acknowledgements

1. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. JAMA 2003;289:2560–72

References and/or AcknowledgementsNo conflict of interest.