Adherence to Antihypertensive Medication in Treatment‐Resistant Hypertension Undergoing Renal Denervation

Abstract

BackgroundAdherence to medication has been repeatedly proposed to represent a major cause of treatment‐resistant hypertension (TRH); however, treatment decisions such as treating TRH with renal denervation depend on accurate judgment of adherence. We carefully analyzed adherence rates to medication before and after renal denervation and its effect on blood pressure (BP) control.Methods and ResultsEighty patients with TRH were included in 2 prospective observational studies that assessed the difference of potential antihypertensive and nephroprotective effects of renal denervation. To compare prescribed with actual medication intake (representing a measure of adherence), we analyzed urine samples collected at baseline and at 6 months after renal denervation for antihypertensive compounds or metabolites (by liquid chromatography–mass spectrometry). In addition to office BP, 24‐hour ambulatory BP and central hemodynamics (central systolic pressure, central pulse pressure) were assessed. Informed consent for analyses of urine metabolites was obtained from 79 of 80 patients. Actual intake of all antihypertensive drugs was detected at baseline and at 6 months after renal denervation in 44 (56%) and 52 (66%) patients, respectively; 1 drug was missing in 22 (28%) and 17 (22%) patients, respectively, and ≥2 drugs were missing in 13 (16%) and 10 (13%) patients, respectively. At baseline, 24‐hour ambulatory BP (P=0.049) and central systolic BP (P=0.012) were higher in nonadherent patients. Adherence did not significantly change overall (McNemar‐Bowker test, P=0.362). An increase in adherence was observed in 21 patients, and a decrease was observed in 11 patients. The decrease in 24‐hour ambulatory BP was not different in those with stable adherence 6 months after renal denervation (n=41, −7±13 mm Hg) compared with those with increased adherence (n=21, −10±13 mm Hg) and decreased adherence (n=11, −7±14 mm Hg) (P>0.20). Our study is limited by the relatively small sample size and potentially by the specific health environment of our university center (Northern Bavaria, Germany).ConclusionsNonadherence to medication among patients with TRH was relatively low: ≈1 of 6 patients with TRH did not take ≥2 of the prescribed drugs. Adherence pattern did not change significantly after renal denervation and had no impact on the overall observed BP changes, supporting the concept that renal denervation is an effective treatment in patients with TRH.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifiers: NCT00888433, NCT01442883 and NCT01687725.

Hypertensive patients’ adherence to pharmacological and non-pharmacological treatment methods, in Turkey

“…8,23,27 In these studies, an increase or decrease in the rate of adherence to the treatment with age may be due to the presence of comorbid chronic diseases, perceived health status, or differences in giving or receiving health care. 7,24 While gender is not a determinant for the rate of adherence to the pharmacological treatment in some studies the adherence rate is high in women in other studies. 8,19 In the present study, although not significant, the rate of adherence was high in women as in the literature.…”

“…Rates of adherence to pharmacological treatment range between 52% and 87% in studies conducted in Turkey and between 48% and 84% in studies conducted abroad. 7,8,12,15,[19][20][21][22][23][24] The WHO has reported that rates of adherence to pharmacological treatment by hypertension patients vary between 20% and 80%. 25 Thus, it can be concluded that the rate of adherence to pharmacological treatment in this present study conducted in a semi-urban region in Turkey overlaps with the rates reported in the literature.…”

Anatomical and procedural determinants of catheter-based renal denervation

“…The adherence to antihypertensive therapy was not specifically investigated in this study. However, two recently published studies indicate that patients decrease their adherence to antihypertensive therapy following renal denervation, with more pronounced reductions observed in patients not responding to treatment in terms of office blood pressure changes [21,22]. All RDN procedures were performed with the first generation Symplicity Flex catheter (Medtronic, MA, U.S.A.).…”

Renal Denervation in Resistant Hypertension and Obstructive Sleep Apnea

“…33 It should be noted, however, that several studies have recently shown that nonadherence to treatment is not affected by RDN, nor did it influence RDN results. [34][35][36][37] Moreover, this limitation is compensated for by strict inclusion criteria and by the fact that all patients maintained their baseline antihypertensive drug regimen for the 3-month follow-up.…”