Nonadherence to antihypertensive medications is related to pill burden in apparent treatment-resistant hypertensive individuals

Abstract

Objective: Non-adherence to medication is present in ≥50% of patients with apparent treatment resistant hypertension. We examined the factors associated with non-adherence as detected by an LC-MS/MS based urine antihypertensive drug assay.Methods: All urine antihypertensive test results, carried out for uncontrolled hypertension (BP persistently >140/90 mmHg) between January 2015 and December 2016 at a single toxicology laboratory were analysed. Drugs detected were compared to the antihypertensive drugs prescribed. Patients were classified as adherent (all drugs detected), partially nonadherent (≥1 prescribed drugs detected) or completely non-adherent (no drugs detected).Demographic and clinical parameters were compared between the adherent and non-adherent groups. Binary logistic regression analysis was performed to determine association between non-adherence and demographic and clinical factors.Results: Data on 300 patients from 9 hypertension centres across the UK were analysed. The median age was 59 years, 47% female, 71% Caucasian , median clinic BP was 176/95 mmHg and the median number of antihypertensive drugs prescribed was four. One hundred and sixty-six (55%) were non-adherent to prescribed medication with 20% of these being completely non-adherent. Non-adherence to antihypertensive medication was independently associated with younger age, female gender, number of antihypertensive drugs prescribed, total number of all medications prescribed (total pill burden) and prescription of a calcium channel blocker. Conclusion:This LC-MS/MS urine analysis-based study suggests the majority of patients with apparent treatment resistant hypertension are non-adherent to prescribed treatment.Factors that are associated with non-adherence, particularly pill burden, should be taken into account while treating these patients.

Preoperative mineralocorticoid receptor antagonist reduces postoperative hyperkalaemia in patients with Conn syndrome

“…Pill burden is a well-recognized issue in patients with hypertension that is associated with nonadherence to medications and poor blood pressure control. 21,22 This study showed that preoperative MRA was associated with a reduction in the number of antihypertensive medications and potassium supplements. Immediately before adrenalectomy, patients who were pretreated with MRA took a median of one antihypertensive medication and no potassium supplements.…”

Device-Based Treatment in Hypertension: At the Forefront of Renal Denervation

“…RDN has been shown to lower BP compared to sham control in both the presence and absence of concomitant drug therapy. Thus, RDN-induced BP reductions are not affected by drug adherence, which is a primary weakness of medication therapy [76,77] . This allows for 24-hour BP control, including at night and early in the morning when the antihypertensive effect of the medication is likely to wear off due to the time course of drug ingestion [78] and pharmacokinetics [2] .…”

“…Thus, RDN-induced BP reductions are not affected by drug adherence, which is a primary weakness of medication thera-py. [76,77] This allows for 24-hour BP control, including at night and early in the morning when the antihypertensive effect of the medication is likely to wear off due to the time course of drug ingestion [78] and pharmacokinetics. [2] Initially, it was thought that the SYMPLICITY HTN-3 trial failed to prove the antihypertensive effect of RDN.…”

Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021

“…This is especially so in those who are on multiple anti-hypertensive and other medications. Urine antihypertensive drug monitoring may help management of these individuals [ 130 ]. Therefore, it is important to assess adherence especially in those not achieving blood pressure control despite taking 3 or more antihypertensive agents in optimum doses.…”