{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:40:01Z","timestamp":1756323601832,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T00:00:00Z","timestamp":1541030400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2018,11,12]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>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\u2009mm 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\u2009mm 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.<\/jats:p>","DOI":"10.1136\/bcr-2018-226045","type":"journal-article","created":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T17:19:47Z","timestamp":1545153587000},"page":"e226045","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Novel stratified medicines approach to manage uncontrolled hypertension due to multiple drug intolerances"],"prefix":"10.1136","volume":"11","author":[{"given":"Catherine","family":"Schuster Bruce","sequence":"first","affiliation":[{"name":"Barts BP Centre of Excellence, William Harvey Research Institute, London, UK"},{"name":"NIHR Barts Cardiovascular Biomedical Research Centre, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gurvinder","family":"Rull","sequence":"additional","affiliation":[{"name":"Barts BP Centre of Excellence, William Harvey Research Institute, London, UK"},{"name":"NIHR Barts Cardiovascular Biomedical Research Centre, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoniou","family":"Sotiris","sequence":"additional","affiliation":[{"name":"Barts BP Centre of Excellence, William Harvey Research Institute, London, UK"},{"name":"NIHR Barts Cardiovascular Biomedical Research Centre, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melvin D","family":"Lobo","sequence":"additional","affiliation":[{"name":"Barts BP Centre of Excellence, William Harvey Research Institute, London, UK"},{"name":"NIHR Barts Cardiovascular Biomedical Research Centre, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,12,13]]},"reference":[{"key":"2025082712073702000_11.1.e226045.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61766-8"},{"key":"2025082712073702000_11.1.e226045.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)11911-8"},{"key":"2025082712073702000_11.1.e226045.3","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1111\/jch.12637","article-title":"Management of hypertensive patients with multiple drug intolerances: a single-center experience of a novel treatment algorithm","volume":"18","author":"Antoniou","year":"2016","journal-title":"J Clin Hypertens"},{"key":"2025082712073702000_11.1.e226045.4","unstructured":"National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management. CG127. London: NICE, 2011."},{"key":"2025082712073702000_11.1.e226045.5","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960140204"},{"key":"2025082712073702000_11.1.e226045.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7404.1427"},{"key":"2025082712073702000_11.1.e226045.7","unstructured":"Boehringer Ingelheim. Boehringer ingelheim catapres-TTS (clonidine). 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