Blood pressure reductions following catheter-based renal denervation are not related to improvements in adherence to antihypertensive drugs measured by urine/plasma toxicological analysis

Abstract

Renal denervation can reduce blood pressure in patients with uncontrolled hypertension. The adherence to prescribed antihypertensive medication following renal denervation is unknown. This study investigated adherence to prescribed antihypertensive treatment by liquid chromatography-high resolution tandem mass spectrometry in plasma and urine at baseline and 6 months after renal denervation in 100 patients with resistant hypertension, defined as baseline office systolic blood pressure ≥140 mmHg despite treatment with ≥3 antihypertensive agents. At baseline, complete adherence to all prescribed antihypertensive agents was observed in 52 patients, 46 patients were partially adherent, and two patients were completely non-adherent. Baseline office blood pressure was 167/88 ± 19/16 mmHg with a corresponding 24-h blood pressure of 154/86 ± 15/13 mmHg. Renal denervation significantly reduced office and ambulatory blood pressure at 6-month follow-up by 15/5 mmHg (p < 0.001/p < 0.001) and 8/4 mmHg (p < 0.001/p = 0.001), respectively. Mean adherence to prescribed treatment was significantly reduced from 85.0 % at baseline to 80.7 %, 6 months after renal denervation (p = 0.005). The blood pressure decrease was not explained by improvements in adherence following the procedure. Patients not responding to treatment significantly reduced their drug intake following the procedure. Adherence was highest for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta blockers (>90 %) and lowest for vasodilators (21 %). In conclusion, renal denervation can reduce office and ambulatory blood pressure in patients with resistant hypertension despite a significant reduction in adherence to antihypertensive treatment after 6 months.

Systolic Blood Pressure and Biochemical Assessment of Adherence

“…Complete non-adherence defined by lack of detection of any prescribed antihypertensive medications ranged from 10% to 54% in studies conducted in specialty clinics or clinical trials. 31–38 Among patients who described themselves as adherent, ~33% were completely non-adherent according to therapeutic drug monitoring, 32, 35 which is similar to our findings of 32% complete non-adherence among the 202 patients who reported being adherent by the ARMS in the current study. The difference of ~20 mm Hg between adherent and non-adherent patients prescribed ≥3 antihypertensives in the current study is also similar to the 18 mm Hg difference between adherent and non-adherent patients referred to a hypertension specialty clinic.…”

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 the era of HTN-3. Comprehensive review and glimpse into the future

“…Does adherence have an impact on the response to RDN? Ewen et al 70 investigated adherence to prescribed antihypertensive treatment by liquid chromatography-high resolution tandem mass spectrometry in plasma and urine at baseline and 6 months in 100 RDN patients and observed that mean adherence was significantly reduced from 85.0% at baseline to 80.7% at 6 months (P ¼ .005). The authors concluded that RDN can reduce office and ambulatory BP in patients with resistant HT despite a significant reduction in adherence to antihypertensive treatment after 6 months.…”