IJCS | Volume 33, Nº2, March / April 2020

127 Figure 3 - Number of antihypertensive drugs according to degree of therapeutic adherence. * In the group with good adherence, the median number of antihypertensive drugs used is 4 (4 - 5), while in the group with poor adherence the mean of antihypertensive drugs is 4,96 (1,17), with p value 0.0313. † The comparison between groups was done by the Mann-Whitney test. Araújo & Aras Junior Therapeutic adherence and resistant hypertension Int J Cardiovasc Sci. 2020; 33(2):121-130 Original Article adherence used, on average, a larger number, with statistical significance (p = 0.0313). Considering the need to exclude pseudoresistance for the diagnosis of true RH, it is estimated that 43 (19.9%) of the patients attending the outpatient clinic presented pseudoresistance, reported through the Morisky test (low adherence), inadequate therapeutic regimen (no inclusion of thiazide diuretic in the scheme) and ABPM (white coat hypertension). Thus, excluding pseudoresistance and considering the criteria for the definition of RH (uncontrolled BP despite the use of 3 or more antihypertensives – one of them being a thiazide diuretic – or BP control only when in use of 4 or more antihypertensives), 108 (50%) individuals attending the outpatient clinic presented true RH. In addition, 36 (16.6%) individuals at the outpatient clinic (33% of patients with true RH) had refractory arterial hypertension (BP uncontrolled despite the use of 5 or more antihypertensives, including a thiazide diuretic). Discussion The prevalence of good therapeutic adherence found in this study (83%) was similar to that found in the ReHOT study, 8 which was approximately 80%, and that found by Garg et al., 9 where it was 84%. However, other studies show lower rates of good adherence, such as 31.3% found by Jesus et al., 10 51.0% found by Bloch et al., 11 and 31.2% found by Prado-Jr , et al. 12 The relatively high rate of good therapeutic adherence in this study can be explained by the fact that patients are followed up at a reference outpatient clinic for Resistant Arterial Hypertension, so more attention is possibly given to the issue of adherence. An analysis of the answers given by the patients in the Morisky test reveals that themain affirmative answer was about the discomfort of correctly following the proposed therapy (27.2%). This provides evidence of the need to ensure that the patient has understood the importance of using medications to control BP. The second and thirdmost prevalent responses were, respectively, about forgetting to take the medications (25.3%) and having difficulty remembering to take the medications (23.6%). Facedwith this reality, it is fundamental to draw together patient and family strategies to help patients remember to take their medications. Another response with considerable prevalence was about discontinuing the use or reducing the dose of medications because of feeling worse (21%). At all appointments, it is the physician’s responsibility to ask patients about any adverse effects and discomfort with the use of the medications in order to, if necessary, change or make dose adjustments, thus avoiding that the patient does so improperly. Literature shows that different factors may contribute to poor therapeutic adherence of hypertensive patients, such as gender, age, education, ethnicity, smoking, alcohol consumption, comorbidities and duration of