Mariampillai Julian E, Eskås Per Anders, Heimark Sondre, Larstorp Anne Cecilie K, Fadl Elmula Fadl Elmula M, Høieggen Aud, Nortvedt Per
a Faculty of Medicine , University of Oslo , Oslo , Norway.
b Department of Medical Biochemistry , Oslo University Hospital, Ullevaal , Oslo , Norway.
Blood Press. 2017 Jun;26(3):133-138. doi: 10.1080/08037051.2016.1277129. Epub 2017 Jan 12.
Poor drug adherence is a major cause of apparent treatment-resistant hypertension. As a consequence, several methods have been developed and attempted implemented in clinical practice to reveal non-adherence and to monitor drug adherence. There are, however, several hitherto unresolved ethical aspects regarding potential methods for drug monitoring in these patients.
The most striking challenge is the balance between patient autonomy and the physician's desire for the patient to adhere to the prescribed therapy. Also, methods for monitoring must only be implemented in the treatment of well-informed and consenting patients. Major resources are used on non-adherent patients; how long the physician should encourage continuation of treatment is an important question.
We believe that physicians should reflect and discuss these potential challenges, and that patient education, information and a solid patient-physician relationship are essential for achieving drug adherence. Methods for monitoring adherence represent, however, a useful and often necessary supplement.
药物依从性差是导致明显难治性高血压的主要原因。因此，已开发出多种方法并尝试在临床实践中应用，以揭示不依从情况并监测药物依从性。然而，对于这些患者潜在的药物监测方法，目前仍存在一些未解决的伦理问题。
最突出的挑战是患者自主权与医生期望患者坚持规定治疗之间的平衡。此外，监测方法只能在充分知情并同意的患者治疗中实施。非依从性患者会消耗大量资源；医生应鼓励持续治疗多长时间是一个重要问题。
我们认为医生应思考并讨论这些潜在挑战，并且患者教育、信息提供以及稳固的医患关系对于实现药物依从性至关重要。然而，监测依从性的方法是一种有用且往往必要的补充。
