Adherence to Antihypertensive Drugs Assessed by Hyphenated High‐Resolution Mass Spectrometry Analysis of Oral Fluids

Abstract

Background It is currently unknown if antihypertensive drugs can be monitored in oral fluid ( OF ) using liquid chromatography coupled to high‐resolution mass spectrometry. Methods and Results We assessed adherence using liquid chromatography coupled to high‐resolution mass spectrometry in OF , plasma, and urine of 56 consecutive patients with hypertension referred to a tertiary hypertension unit. Of these patients, 59% were completely adherent (all drugs detectable in urine), whereas 29% and 13% were partially adherent (1 drug not detectable in urine) or nonadherent (>1 drug not detectable in urine), respectively. Adherent patients were on fewer antihypertensive drugs ( P =0.001), had fewer daily drug doses ( P =0.012), and had lower 24‐hour ambulatory systolic ( P =0.012) and diastolic ( P =0.009) blood pressures than nonadherent or partially adherent patients. Most drugs were detected in urine compared with plasma and OF (181 versus 119 versus 88; P =0.001). Compared with urine and plasma, detection rates of angiotensin‐converting enzyme inhibitors, angiotensin II receptor blockers, and diuretics were lower in OF . There was no difference in the frequency of detecting β blockers ( P =1.0) and calcium channel blockers ( P =0.063) when comparing OF with urine. There was no difference in the number of calcium channel blockers ( P =0.727), β blockers ( P =1.000), thiazide diuretics ( P =0.125), and α‐2 agonists ( P =0.125) identified between OF and plasma. Conclusions This study shows the feasibility of drug adherence testing for several antihypertensive drugs, especially those without acidic components, in OF , with a similar recovery compared with plasma. Therefore, drug adherence testing in OF should be further explored as a noninvasive approach, which can easily be performed in an “out‐of‐office” setting.

On the issue of low adherence of patients to antihypertensive therapy: the use of therapeutic drug monitoring of drugs: A review

“…Кроме того, разработаны и валидированы другие прямые методы -качественный метод оценки приверженности АГП, например, по анализу ротовой жидкости [12,13].…”

Detection of Nonadherence to Antihypertensive Treatment by Measurements of Serum Drug Concentrations

“…Other methods of antihypertensive agent detection in body fluids exist. Although urine analysis is the most commonly used, other methods such as detection in oral fluids or dried blood spots are currently being investigated 126,127 . The main advantage of serum drug measurement over urine detection of drugs is that it allows not only detection of antihypertensive agents, but also their quantification.…”

“…There is considerable variation in the extent of nonadherence among patients with hypertension, largely depending on the particular method of assessment that has been applied. 10,13–15…”

“…There is considerable variation in the extent of nonadherence among patients with hypertension, largely depending on the particular method of assessment that has been applied. 10,[13][14][15] In this nationwide cross-sectional multicenter cohort study, we aimed to assess the prevalence of nonadherence among Norwegian hypertensive patients using ≥2 antihypertensive agents by using direct measurements of serum drug concentrations, characterize drug regimens in nonadherent patients, and investigate other associated factors of nonadherence to antihypertensive medication. In addition, we aimed to assess the accuracy of 2 indirect methods namely patient-reported nonadherence and physician-reported nonadherence, by comparing them to the direct method of serum drug concentrations.…”

Análise do mecanismo de ação do Alfa-Terpineol em células de músculo liso A7r5

“…Na grande maioria das vezes ela é assintomática e é necessário manter uma regularidade das mensurações da PA no consultório médico onde também será avaliado quais possíveis fatores de risco para indicação de um tratamento mais ajustado(OPARIL et al, 2018).Novas abordagens farmacológicas são necessárias para melhorar o controle da PA e, claro, a resposta dos pacientes aos medicamentos também são vitais no desenvolvimento dessas novas abordagens(LOBO et al, 2017). Consequentemente, avaliar a adesão dos pacientes hipertensos é uma etapa importante do tratamento para orientar melhores intervenções farmacológicas e que sejam mais especificas(LAUDER et al, 2020).O tratamento da HAS tem como propósito impedir a progressão da doença ou complicações oriundas, proporcionar qualidade de vida a essas pessoas, reduzindo a morbimortalidade(MARTÍNEZ-SÁMANO et al, 2018). Os medicamentos disponíveis no mercado estão agrupados em classes conforme seus mecanismos de ação.…”