scholarly journals Nonadherence in Hypertension: How to Develop and Implement Chemical Adherence Testing

Hypertension ◽  
2021 ◽  
Author(s):  
Dan Lane ◽  
Alexander Lawson ◽  
Angela Burns ◽  
Michel Azizi ◽  
Michel Burnier ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Resistant Hypertension ◽  
Antihypertensive Medication ◽  
Antihypertensive Drugs ◽  
Test Results ◽  
Sample Collection ◽  
Treatment Resistant ◽  
Blood Samples ◽  
Hypertensive Patients ◽  
Adherence Test

Nonadherence to antihypertensive medication is common, especially in those with apparent treatment-resistant hypertension (true treatment-resistant hypertension requires exclusion of nonadherence), and its routine detection is supported by clinical guidelines. Chemical adherence testing is a reliable and valid method to detect adherence, yet methods are unstandardized and are not ubiquitous. This article describes the principles of chemical adherence testing for hypertensive patients and provides a set of recommendations for centers wishing to develop the test. We recommend testing should be done in either of two instances: (1) in those who have resistant hypertension or (2) in those on 2 antihypertensives who have a less than 10 mm Hg drop in systolic blood pressure on addition of the second antihypertensive medication. Furthermore, we recommend that verbal consent is secured before undertaking the test, and the results should be discussed with the patient. Based on medications prescribed in United Kingdom, European Union, and United States, we list top 20 to 24 drugs that cover >95% of hypertension prescriptions which may be included in the testing panel. Information required to identify these medications on mass spectrometry platforms is likewise provided. We discuss issues related to ethics, sample collection, transport, stability, urine versus blood samples, qualitative versus quantitative testing, pharmacokinetics, instrumentation, validation, quality assurance, and gaps in knowledge. We consider how to best present, interpret, and discuss chemical adherence test results with the patient. In summary, this guidance should help clinicians and their laboratories in the development of chemical adherence testing of prescribed antihypertensive drugs.

scholarly journals Improvement of Blood Pressure Control by Adherence Check in Patients With Apparent Treatment-Resistant Hypertension: A Case Series

2020 ◽  
Vol 13 ◽  
pp. 117954762090488
Author(s):  
Keiko Hosohata ◽  
Ayaka Inada ◽  
Saki Oyama ◽  
Takashi Doi ◽  
Iku Niinomi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Case Series ◽  
Pressure Control ◽  
Supporting Evidence ◽  
Treatment Resistant ◽  
Uncontrolled Blood Pressure ◽  
Important Challenge ◽  
Prescribed Medicines

Adherence to medications is an important challenge while treating chronic disease such as resistant hypertension, which is defined as uncontrolled blood pressure (BP) despite treatment with more than 3 antihypertensive drugs to achieve targets. It is possible that poor adherence is the most significant contributor to rates of pseudo-resistance among treated hypertensive patients. In this report, we describe 4 patients with apparent treatment-resistant hypertension, who received intervention to promote adherence by pharmacists who set the prescribed medicines in a weekly medication calendar and conducted a weekly pill count. The results showed that the intervention of pharmacists to medication adherence improved systolic BP in patients with apparent treatment-resistant hypertension; however, further controlled trials are required to strengthen supporting evidence.

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

2016 ◽  
Vol 5 (2) ◽  
Author(s):  
Roland E. Schmieder ◽  
Christian Ott ◽  
Axel Schmid ◽  
Stefanie Friedrich ◽  
Iris Kistner ◽  
...  
Keyword(s):  
Resistant Hypertension ◽  
Antihypertensive Medication ◽  
Renal Denervation ◽  
Treatment Resistant

1422Prevalence and characteristics of medication non-adherence assessed by quantitative liquid chromatography-tandem mass spectrometry in patients with hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M E A M Van Kleef ◽  
E M Van Maarseveen ◽  
F L J Visseren ◽  
P J Blankestijn ◽  
M L Bots ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Tandem Mass Spectrometry ◽  
Calcium Antagonists ◽  
Clinical Characteristics ◽  
Antihypertensive Medication ◽  
Beta Blockers ◽  
Tandem Mass ◽  
Hypertensive Patients ◽  
Chromatography Tandem Mass Spectrometry ◽  
Quantitative Screening

Abstract Background/Introduction Antihypertensive medication screening by qualitative high performance chromatography-tandem mass spectrometry (LC-MS/MS) has recently become available to detect non-adherence to antihypertensive treatment. Because the result of this test is dichotomous (the drug is detected or not), it may incorrectly classify patients who take their medications infrequently. Therefore, a quantitative screening method has been developed to improve detection of non-adherence. Purpose The aim of this study was to determine the prevalence of medication non-adherence assessed by quantitative LC-MS/MS in referred hypertensive patients. In addition, we determined to what extent clinical characteristics, prescribed medication and self-reported perspectives, were associated with medication non-adherence assessed by quantitative LC-MS/MS. Methods In this cross-sectional study we included 197 newly referred hypertensive patients (mean age 56±14 years, 101 women, mean 24-hour ambulatory blood pressure 143/85±21/12 mmHg) prescribed at least one antihypertensive drug. Medication adherence was assessed by quantitative LC-MS/MS in plasma. The concentration of each prescribed drug (or its metabolite) was measured and divided by the literature-based population trough concentration, to get the concentration ratio (CR). If the CR of at least one of the prescribed drugs was ≤0.3 the patient was categorized as non-adherent: completely non-adherent if all were ≤0.3, partially non-adherent if not all were ≤0.3. Logistic regression analysis was performed to determine the association between clinical characteristics, prescribed medication and self-reported compliance (Hill & Bone), relational empathy (CARE) and beliefs about medicines (BMQ), and medication non-adherence. Results 29% was classified as partially non-adherent and 10% as completely non-adherent. Non-adherence to calcium antagonists (30%) and beta blockers (24%) prevailed non-adherence to other antihypertensive medication classes (6–11%). The odds of non-adherence were higher in patients with apparent resistant hypertension and increased with the number of antihypertensive medication types, tablets and daily defined dose prescribed (Figure 1). Combination pills were inversely associated with non-adherence. Self-reported measures were not associated. Older age was negatively associated with non-adherence to RAS inhibitors (OR 0.60, 95% CI 0.36–0.96) and beta blockers (OR 0.50, 95% CI 0.30–0.77). Figure 1 Conclusions Quantitative screening by LC-MS/MS in plasma shows a high prevalence of non-adherence in referred hypertensive patients, particularly for calcium antagonists and beta blockers. The observation that clinical characteristics and self-reported perspectives about medical treatment were not associated with non-adherence, supports the use of quantitative LC-MS/MS to detect non-adherence to antihypertensive medication in daily practice.

scholarly journals Underutilization of Treatment for Black Adults With Apparent Treatment-Resistant Hypertension

Hypertension ◽  
2020 ◽  
Vol 76 (5) ◽  
pp. 1600-1607
Author(s):  
Aisha T. Langford ◽  
Oluwasegun P. Akinyelure ◽  
Tony L. Moore ◽  
George Howard ◽  
Yuan-I Min ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Resistant Hypertension ◽  
Mineralocorticoid Receptor ◽  
Antihypertensive Medication ◽  
Healthy Lifestyle ◽  
Lifestyle Factors ◽  
Mineralocorticoid Receptor Antagonists ◽  
Treatment Resistant ◽  
Black Adults

Resistant hypertension, defined as blood pressure levels above goal while taking ≥3 classes of antihypertensive medication or ≥4 classes regardless of blood pressure level, is associated with increased cardiovascular disease risk. The 2018 American Heart Association Scientific Statement on Resistant Hypertension recommends healthy lifestyle habits and thiazide-like diuretics and mineralocorticoid receptor antagonists for adults with resistant hypertension. The term apparent treatment-resistant hypertension (aTRH) is used when pseudoresistance cannot be excluded. We estimated the use of healthy lifestyle factors and recommended antihypertensive medication classes among US Black adults with aTRH. Data were pooled for Black participants in the JHS (Jackson Heart Study) in 2009 to 2013 (n=2496) and the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) in 2013 to 2016 (n=3786). Outcomes included lifestyle factors (not smoking, not consuming alcohol, ≥75 minutes of vigorous-intensity or ≥150 minutes of moderate or vigorous physical activity per week, and body mass index <25 kg/m 2 ) and recommended antihypertensive medications (thiazide-like diuretics and mineralocorticoid receptor antagonists). Overall, 28.3% of participants who reported taking antihypertensive medication had aTRH. Among participants with aTRH, 14.5% and 1.2% had ideal levels of 3 and 4 of the lifestyle factors, respectively. Also, 5.9% of participants with aTRH reported taking a thiazide-like diuretic, and 9.8% reported taking a mineralocorticoid receptor antagonist. In conclusion, evidence-based lifestyle factors and recommended pharmacological treatment are underutilized in Black adults with aTRH. Increased use of lifestyle recommendations and antihypertensive medication classes specifically recommended for aTRH may improve blood pressure control and reduce cardiovascular disease–related morbidity and mortality among US Black adults. Graphic Abstract A graphic abstract is available for this article.

scholarly journals Effect of Losartan and Amlodipine on Lung Function Status in Hypertensive Patients: A Randomized Control Trial

2020 ◽  
Vol 15 (1) ◽  
pp. 42-44
Author(s):  
Mst Nasrin Nahar ◽  
Shelina Begum ◽  
Sultana Ferdousi ◽  
Tamanna Habib
Keyword(s):  
Essential Hypertension ◽  
Lung Function ◽  
Antihypertensive Medication ◽  
Antihypertensive Drugs ◽  
Armed Forces ◽  
Control Group ◽  
Angiotensin Ii Receptor Blocker ◽  
Newly Diagnosed ◽  
Angiotensin Ii Receptor ◽  
Hypertensive Patients

Introduction: Essential hypertension is associated with altered pulmonary function. Antihypertensive medication and lung function are also associated. Losartan (angiotensin II receptor blocker) and amlodipine (calcium channel blocker) are commonly used antihypertensive drugs. Objectives: To evaluate the effects of antihypertensive drugs on lung function status in patients with essential hypertension. Materials and Methods: This prospective observational study was carried out in the Department of Physiology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, from July 2012 to June 2013 on 100 newly diagnosed hypertensive patients without any antihypertensive medication (group B, age 30-55 years). They were selected from the Out Patient Department (OPD) of Cardiology, BSMMU, Dhaka. Age, sex and BMI matched 50 apparently healthy normotensive subjects were also studied as control (group A). Based on treatment, these study subjects were divided into two groups (B1 and B2). Group B1 included 50 patients received losartan 50 mg daily and B2 included 50 patients received amlodipine 5 mg daily. They were observed once before the treatment (B1a and B2a), after 3 months of medication (B1b and B2b) and after 6 months of medication (B1c and B2c). For assessing lung function status, Forced Vital Capacity (FVC), Forced Expiratory Volume in 1st second (FEV1) and Peak Expiratory Flow Rate (PEFR) were measured with a RMS computer based Spirometer. Results: Mean FVC, FEV1 and PEFR were significantly lower in newly diagnosed hypertensive patients in comparison with that of healthy normotensive. Mean FVC, FEV1 and PEFR were found significantly higher in the group taking losartan and amlodipine for 6 months when compared to newly diagnosed but lower than those of controls. Conclusion: Reduced lung function occurs in newly diagnosed hypertensive patients which was improved by treatment with losartan and amlodipine. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 42-44

scholarly journals Effect of Antihypertensive Therapy on Blood Rheology in Patients with Essential Hypertension

2005 ◽  
Vol 33 (2) ◽  
pp. 170-177 ◽  
Author(s):  
H Sumino ◽  
M Nara ◽  
K Seki ◽  
T Takahashi ◽  
T Kanda ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Essential Hypertension ◽  
Antihypertensive Drugs ◽  
Blood Rheology ◽  
Passage Time ◽  
Blood Samples ◽  
Hypertensive Patients ◽  
Display Unit ◽  
Normotensive Subjects

Hypertension is an important risk factor for cardiovascular disease, and antihypertensive drugs can decrease the occurrence of such events in hypertensive patients. This study compared the rheological properties of blood in 22 untreated hypertensive patients, 42 patients taking antihypertensive drugs and 74 normotensive subjects. Using a microchannel method, the whole blood passage time was measured and blood movement was observed with a microscope connected to an image display unit. The blood passage time in untreated hypertensive patients was significantly higher than in treated hypertensive patients or normotensive subjects, but was similar in the latter two groups. Microscopic observations showed that platelet aggregation and leucocyte adhesion were increased in untreated hypertensive patients, resulting in poor flow, while blood samples from treated hypertensive patients and normotensive subjects passed smoothly through the microchannels. These rheological differences could contribute to the decrease in cardiovascular disease seen when hypertensive patients are treated effectively.

scholarly journals Treatment resistant hypertension among ambulatory hypertensive patients: A cross sectional study

PLoS ONE ◽  
2020 ◽  
Vol 15 (4) ◽  
pp. e0232254
Author(s):  
Solomon Weldegebreal Asgedom ◽  
Kidus Amanuel ◽  
Meles Tekie Gidey ◽  
Yirga Legesse Niriayo ◽  
Kidu Gidey ◽  
...  
Keyword(s):  
Resistant Hypertension ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Treatment Resistant ◽  
Cross Sectional ◽  
Hypertensive Patients

scholarly journals Genetic and Adverse Health Outcome Associations with Treatment Resistant Hypertension in GenHAT

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Amy I. Lynch ◽  
Marguerite R. Irvin ◽  
Barry R. Davis ◽  
Charles E. Ford ◽  
John H. Eckfeldt ◽  
...  
Keyword(s):  
Resistant Hypertension ◽  
Genetic Variants ◽  
Antihypertensive Medication ◽  
Genetic Basis ◽  
Uncontrolled Hypertension ◽  
Treatment Resistant ◽  
Adverse Health Outcome ◽  
Genetic Studies ◽  
Similar Association ◽  
Agt Gene

Treatment resistant hypertension (TRH) is defined as uncontrolled hypertension (HTN) despite the use of ≥3 antihypertensive medication classes or controlled HTN while treated with ≥4 antihypertensive medication classes. Risk factors for TRH include increasing age, diminished kidney function, higher body mass index, diabetes, and African American (AA) race. Importantly, previous studies suggest a genetic role in TRH, although the genetics of TRH are largely understudied. With 2203 treatment resistant cases and 2354 treatment responsive controls (36% AA) from the Genetics of Hypertension Associated Treatment Study (GenHAT), we assessed the association of 78 candidate gene polymorphisms with TRH status using logistic regression. After stratifying by race and adjusting for potential confounders, there were 2 genetic variants in the AGT gene (rs699, rs5051) statistically significantly associated with TRH among white participants. The Met allele of rs699 and the G allele of rs5051 were positively associated with TRH:OR=1.27 (1.12–1.44),P=0.0001, andOR=1.36 (1.20–1.53),P<0.0001, respectively. There was no similar association among AA participants (race interactionP=0.0004for rs699 andP=0.0001for rs5051). This research contributes to our understanding of the genetic basis of TRH, and further genetic studies of TRH may help reach the goal of better clinical outcomes for hypertensive patients.

RESISTANT ARTERIAL HYPERTENSION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: PREVALENCE, PROGNOSTIC SIGNIFICANCE, REASONS AND APPROACHES TO ANTIHYPERTENSIVE THERAPY

2019 ◽  
Vol 23 (1) ◽  
pp. 37-44 ◽  
Author(s):  
O. B. Kuzmin ◽  
V. V. Zhezha ◽  
L. N. Landar ◽  
O. A. Salova
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Drug Therapy ◽  
Kidney Disease ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Refractory Hypertension ◽  
Hypertensive Patients

Arterial hypertension (AH) resistant to drug therapy is the phenotype of uncontrolled AH, in which patients receiving at least 3 antihypertensive drugs, including a diuretic, maintain blood pressure above the target level. Initially, the term refractory hypertension was also used to refer to resistant hypertension. Recently, however, refractory hypertension has been isolated into a separate phenotype of difficult to treat hypertension, which is defined as insufficient control of target blood pressure, despite the use of at least 5 different mechanisms of antihypertensive drugs, including long-acting diuretic and antagonist of mineralcorticoid receptors. Resistant hypertension is detected in 10–15 % of all hypertensive patients receiving drug therapy, and is often found in patients with chronic kidney disease. Hypertension can be a cause and/or consequence of kidney damage and is typical of most patients with chronic kidney disease. The lack of control of target blood pressure in a significant proportion of hypertensive patients with CKD who receive at least 3 antihypertensive drugs of different mechanisms of action indicates a lack of effectiveness of antihypertensive therapy, which not only accelerates the loss of renal function, but also significantly worsens the prognosis, contributing to such people risk of cardiovascular and renal complications. The review presents data on the prevalence, prognostic value of resistant hypertension in patients with chronic kidney disease, features of its formation and approaches to increasing the effectiveness of antihypertensive therapy in this patient population.

Sign in / Sign up

Export Citation Format

Share Document