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Novel stratified medicines approach to manage uncontrolled hypertension due to multiple drug intolerances
  1. Catherine Schuster Bruce1,2,
  2. Gurvinder Rull1,2,
  3. Antoniou Sotiris1,2 and
  4. Melvin D Lobo1,2
  1. 1 Barts BP Centre of Excellence, William Harvey Research Institute, London, UK
  2. 2 NIHR Barts Cardiovascular Biomedical Research Centre, London, UK
  1. Correspondence to Dr Melvin D Lobo, m.d.lobo{at}


A 61-year-old man with a 30-year history of uncontrolled hypertension was unable to tolerate conventional antihypertensive medications from all classes. At the time of referral to our centre he had discontinued all antihypertensive drugs and felt well. However, his average home blood pressure (HBP) reading was 179/125 mm Hg and echocardiography demonstrated moderate concentric left ventricular hypertrophy. A novel stratified medicines algorithm was used to guide treatment entailing transdermal clonidine patch therapy instead of tablet formulations. Sixteen months later, his average HBP was 147/106 mm Hg with no side effects and the left ventricular hypertrophy had completely regressed. Our experience has taught us that multiple drug intolerance is a common, often overlooked, cause of non-adherence to antihypertensive medication. This case demonstrates the benefit of a novel approach to optimise blood pressure control and emphasises the important role of hypertension specialists in managing complex, high-risk patients unable to tolerate guideline-based therapy.

  • hypertension
  • cardiovascular medicine
  • drug interactions
  • cardiovascular system

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  • Contributors CSB undertook patient review, data collection and data analysis. She wrote the original draft of the manuscript and coordinated revision of the subsequent drafts. GR and AS were involved in management of patient and made substantial contribution to the conception of the case report. ML supervised the management of the patient and conceived of the case report. All authors were involved in revising the original draft of the manuscript and have all read and approved the submission of the final version. All authors have agreed to be accountable for the case report. The case report has not been published and is not being considered for publication elsewhere, in whole or in part, in any language.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ML is supported by the Barts Charity and has received speaker honoraria and consultancy fees from CVRx, St Jude Medical, ROX Medical and Cardiosonic. AS reports personal fees from Bayer Healthcare, Pfizer BMS, Daiichi Sankyo, Boehringer Ingelheim and Portola. All of which are outside the submitted work.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.