Comparison of Morisky Medication Adherence Scale with therapeutic drug monitoring in apparent treatment–resistant hypertension

Abstract

The Morisky Medication Adherence Scale (MMAS-8) is a questionnaire developed for screening of non-adherence in patients with several chronic conditions, including uncomplicated hypertension. However, its accuracy in predicting nonadherence in patients with apparent treatment-resistant hypertension (a-TRH) is not known. Accordingly, we performed a retrospective study in 47 patients with a-TRH who had completed the eight-item MMAS during the initial clinic visit. Non-adherence was defined as presence of undetected serum levels of at least one prescribed antihypertensive drug by therapeutic drug monitoring. We found that 26% of patients were considered to have low adherence score (<6), while the actual prevalence of non-adherence was 51% by therapeutic drug monitoring. Sensitivity of the MMAS-8 was 26% (95% confidence interval, 10.3%-48.4%) with specificity of 75% (95% confidence interval, 53.3%-90.2%). By multivariate analysis, the MMAS-8 score was not an independent predictor of non-adherence, while certain clinical parameters such as heart rate were found to be independent predictors of non-adherence. Our study suggested limited accuracy of the MMAS-8 in detecting medication non-adherence in a-TRH. J Am Soc Hypertens 2015;9(6):420-426.

Non-Adherence to Antihypertensive Drugs: A Systematic Review and Meta-Analysis

“…Finally, 28 articles were included in the systematic review and 25 of these were included in the meta-analysis. [9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][27][28][29][30][31][33][34][35][36] …”

“…Nine of the studies were conducted in the United States, [11,12,15,26,29,30,32,33,35] and 2 each in China, [11,17] Nigeria, [16,22] Hong Kong, [21,25] and Iran. [10,18] Countries such as Uganda, Lebanon, Kenya, Republic of Korea, Peru, Ethiopia, Ghana, Malaysia, Palestine, Brazil, and Italy were represented with a single study.…”

“…[9,13,19,20,23,24,27,28,31,34,36] These studies were conducted on hypertensive patients to assess medication adherence using MMAS-8 between January 2009 and March 2016. Twenty-four studies were cross-sectional [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and others were cohort, [35] observational, [36] and interventional studies. [32] Only 1 randomized controlled trial (RCT) was found.…”

“…[35] However, 8 studies did not specify the type of MMAS-8 questionnaire administered. [9,11,12,15,16,19,27,28] Except 1 study, [22] all the included studies met the quality criteria and showed high quality (>75%). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][29][30][31][32][33][34][35][36] …”

Renal Denervation in Resistant Hypertension and Obstructive Sleep Apnea

“…According to the protocol, the assessment of treatment compliance was assessed by the structured anamnesis based on the Morisky medication adherence scale, which was suggested to have limited accuracy in detecting medication nonadherence in patients with resistant hypertension by Pandey et al The results of this small study were published after all patients in the presented study were recruited, at which point no changes to the protocol were allowed. 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.…”