Precise assessment of noncompliance with the antihypertensive therapy in patients with resistant hypertension using toxicological serum analysis

Štrauch, Branislav; Petrák, Ondřej; Zelinka, Tomáš; Rosa, Ján; Šomlóová, Zuzana; Indra, T.; Chytil, Lukáš; Marešová, Vilma; Kurcová, Ivana; Holaj, Robert; Wichterle, Dan; Widimský, Jiří

doi:10.1097/hjh.0b013e3283652c61

Cited by 146 publications

(96 citation statements)

References 27 publications

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“…The minimal variation and relatively high rates of self-management reported when the Hill-Bone measurement instrument was administered to our study population at baseline, combined with the findings of two subsequent publications about the psychometric properties of the Hill-Bone [24,25], suggest that the tool may not be an ideal research instrument. The current literature indicates that about 50% of patients traditionally classified with resistant hypertension are effectively nonadherent [26,27]. In contrast, our study participants' baseline compliance score on the Hill-Bone medication subscale range was 11.5-11.7 out of a potential range of 9-28 with lower scores indicating greater adherence, suggesting a far higher rate of medication compliance than probable by the fact that all patients were selected because their BP was not controlled.…”

Section: Discussioncontrasting

confidence: 51%

Home-based interventions for black patients with uncontrolled hypertension: a cluster randomized controlled trial

et al. 2016

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Aim: Assess the comparative effectiveness of two blood pressure (BP) control interventions for black patients with uncontrolled hypertension. Patients & methods: A total of 845 patients were enrolled in a three-arm cluster randomized trial. On admission of an eligible patient, field nurses were randomized to usual care, a basic or augmented intervention. Results: Across study arms there were no significant 12 months differences in BP control rates (primary outcome) (25% usual care, 26% basic intervention, 22% augmented intervention); systolic BP (143.8 millimeters of mercury [mmHg], 146.9 mmHG, 143.9 mmHG, respectively); medication intensification (47, 43, 54%, respectively); or self-management score (18.7, 18.7, 17.9, respectively). Adjusted systolic BP dropped more than 10 mmHg from baseline to 12 months (155.5-145.4 mmHg) among all study participants. Conclusion: Neither the augmented nor basic intervention was more effective than usual care in improving BP control, systolic BP, medication intensification or patient self-management. Usual home care yielded substantial improvements, creating a high comparative effectiveness threshold. Clinical Trial Registration: NCT00139490.

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Section: Discussioncontrasting

confidence: 51%

Home-based interventions for black patients with uncontrolled hypertension: a cluster randomized controlled trial

et al. 2016

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“…In all of these studies carried out in TRH or hypertensive patients with insufficient BP control, LC‐MS/MS was used to measure the drug levels, allowing a comparison of adherence rates. The definition of partial nonadherence, however, varies widely from “at least one or more substances missing” to “fewer than prescribed” or is not described in detail at all 14, 15, 16, 17. In our study, we used only 1 antihypertensive substances missing for the definition of partial adherence.…”

Section: Discussionmentioning

confidence: 99%

“…Electronic methods of adherence monitoring (ie, computerized records of pharmacy prescription or electronic monitoring of pill box opening) may be considered reliable alternatives, but it remains subject to the patient's behavior whether the removed pills are indeed ingested 1, 12, 13. Recently, toxicological urine analysis of the compounds or their metabolites has gained increasing interest 14, 15, 16, 17. These biochemical analyses represent spot assessments of adherence but are subject to the “white coat adherence” effect 18, 19.…”

Section: Introductionmentioning

confidence: 99%

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

Schmieder

Ott

Schmid

et al. 2016

JAHA

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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.

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“…1 Recent studies from our group and others have reported a high prevalence of non-adherence to antihypertensive medications among patients with a-TRH (50-60%) using the highly sensitive technique of therapeutic drug monitoring. [2][3][4][5] Despite the enormous burden of non-adherence to the health care system, practical and reliable methods of adherence detection are not well developed. Adherence can be monitored by several methods such as patient self-report, detailed questionnaire, pill counts, prescription fill rate, or electronic pillboxes.…”

Section: Introductionmentioning

confidence: 99%

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

Pandey

Raza

Velasco

et al. 2015

Journal of the American Society of Hypertension

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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.

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Precise assessment of noncompliance with the antihypertensive therapy in patients with resistant hypertension using toxicological serum analysis

Cited by 146 publications

References 27 publications

Home-based interventions for black patients with uncontrolled hypertension: a cluster randomized controlled trial

Home-based interventions for black patients with uncontrolled hypertension: a cluster randomized controlled trial

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

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

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