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Palermiti A, Pappaccogli M, Rabbia F, D'Avolio A, Veglio F. Multiple drug intolerance in antihypertensive patients: what is known and what is missing. J Hypertens 2024; 42:1289-1297. [PMID: 38690922 DOI: 10.1097/hjh.0000000000003737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Drug allergy and intolerance are increasingly recognized as significant public health concerns, leading to adverse reactions in patients undergoing pharmacological treatments. Multiple drug intolerance syndrome (MDIS), characterized by adverse reactions to at least three different drug classes without a clear immunological mechanism, poses a substantial challenge, particularly in hypertensive patients. Despite its link to suboptimal adherence and uncontrolled blood pressure, MDIS in the context of hypertension remains insufficiently explored. This review synthesizes existing literature on MDIS, emphasizing clinical characteristics, pathogenesis, and psychiatric comorbidity. Furthermore, it delves into MDIS in the context of hypertension, highlighting the importance of a multidisciplinary approach in diagnosis and management, including innovative therapeutic strategies such as novel therapeutic algorithms or renal denervation. The review concludes by emphasizing the necessity for further research and clinical trials to enhance our understanding and address MDIS, especially in hypertensive patients.
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Affiliation(s)
| | - Marco Pappaccogli
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Franco Rabbia
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
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Shin W, Lee DH, Yoo H, Jung H, Bang M, Kim A. Assessing the Clinical Efficacy of Therapeutic Drug Monitoring for Risperidone and Paliperidone in Patients with Schizophrenia: Insights from a Clinical Data Warehouse. Pharmaceuticals (Basel) 2024; 17:882. [PMID: 39065735 PMCID: PMC11280477 DOI: 10.3390/ph17070882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/01/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
This study investigated the usage patterns and impact of therapeutic drug monitoring (TDM) for risperidone and paliperidone in patients diagnosed with schizophrenia, utilizing retrospective real-world data sourced from a single center's Clinical Data Warehouse. Our study cohort comprised patients diagnosed with schizophrenia undergoing treatment with either risperidone or paliperidone. Data on demographic characteristics, comorbidities, medication utilization, and clinical outcomes were collected. Patients were categorized into two groups: those undergoing TDM and those not undergoing TDM. Additionally, within the TDM group, patients were further stratified based on their risperidone and paliperidone concentrations relative to the reference range. The findings revealed that patients in the TDM group received higher risperidone and paliperidone doses (320 mg/day and 252 mg/day, p = 0.0045) compared to their non-TDM counterparts. Nevertheless, no significant disparities were observed in hospitalization rates, duration of hospital stays, or compliance between the two groups (p = 0.9082, 0.5861, 0.7516, respectively). Subgroup analysis within the TDM cohort exhibited no notable distinctions in clinical outcomes between patients with concentrations within or surpassing the reference range. Despite the possibility of a selection bias in assigning patients to the groups, this study provides a comprehensive analysis of TDM utilization and its ramifications on schizophrenia treatment outcomes.
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Affiliation(s)
- Wonsuk Shin
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si 13496, Republic of Korea; (W.S.); (H.Y.); (H.J.)
- Department of Physiology, School of Medicine, CHA University, Seongnam-si 13488, Republic of Korea;
| | - Dong Hyeon Lee
- Department of Physiology, School of Medicine, CHA University, Seongnam-si 13488, Republic of Korea;
| | - Hyounggyoon Yoo
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si 13496, Republic of Korea; (W.S.); (H.Y.); (H.J.)
- Department of Pharmacology, School of Medicine, CHA University, Seongnam-si 13488, Republic of Korea
| | - Huiyoung Jung
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si 13496, Republic of Korea; (W.S.); (H.Y.); (H.J.)
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si 13496, Republic of Korea
| | - Anhye Kim
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si 13496, Republic of Korea; (W.S.); (H.Y.); (H.J.)
- Department of Pharmacology, School of Medicine, CHA University, Seongnam-si 13488, Republic of Korea
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Lee FK, Chan NJY, Krishnan P, Datu Abdul Salam DS, Chee XW, Muhamad A, Low YY, Ting KN, Lim KH. Preparation and Preliminary Structure-Activity Relationship Studies of Schwarzinicine A Analogs as Vasorelaxant Agents. JOURNAL OF NATURAL PRODUCTS 2024; 87:675-691. [PMID: 38442031 DOI: 10.1021/acs.jnatprod.3c00707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Schwarzinicines A-D, a series of alkaloids recently discovered from Ficus schwarzii, exhibit pronounced vasorelaxant activity in rat isolated aorta. Building on this finding, a concise synthesis of schwarzinicines A and B has been reported, allowing further investigations into their biological properties. Herein, a preliminary exploration of the chemical space surrounding the structure of schwarzinicine A (1) was carried out aiming to identify structural features that are essential for vasorelaxant activity. A total of 57 analogs were synthesized and tested for vasorelaxant activity in rat isolated aorta. Both efficacy (Emax) and potency (EC50) of these analogs were compared. In addition to identifying structural features that are required for activity or associated with potency enhancement effect, four analogs showed significant potency improvements of up to 40.2-fold when compared to 1. Molecular dynamics simulation of a tetrameric 44-bound transient receptor potential canonical-6 (TRPC6) protein indicated that 44 could potentially form important interactions with the residues Glu509, Asp530, Lys748, Arg758, and Tyr521. These results may serve as a foundation for guiding further structural optimization of the schwarzinicine A scaffold, aiming to discover even more potent analogs.
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Affiliation(s)
- Fong-Kai Lee
- Faculty of Pharmacy and Biomedical Sciences, MAHSA University, 42610 Jenjarom, Selangor, Malaysia
| | | | - Premanand Krishnan
- Foundation in Science, University of Nottingham Malaysia, 43500 Semenyih, Selangor, Malaysia
| | | | - Xavier Wezen Chee
- School of Engineering and Science, Swinburne University of Technology Sarawak, 93350 Kuching, Sarawak, Malaysia
| | - Azira Muhamad
- Malaysia Genome Institute, Jalan Bangi, 43000 Kajang, Selangor, Malaysia
| | - Yun-Yee Low
- Department of Chemistry, Faculty of Science, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Kang-Nee Ting
- School of Pharmacy, University of Nottingham Malaysia, 43500 Semenyih, Selangor, Malaysia
| | - Kuan-Hon Lim
- School of Pharmacy, University of Nottingham Malaysia, 43500 Semenyih, Selangor, Malaysia
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Lozada-Zapata A, Piscoya J, Shiraishi-Zapata C, Mendieta-Albañil W. [Quality of life and therapeutic adherence in a hypertension program]. Rev Salud Publica (Bogota) 2023; 22:618-625. [PMID: 36753080 DOI: 10.15446/rsap.v22n6.88007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/29/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To determine the association between treatment adherence and health-related quality of life. METHODS AND MATERIALS A cross-sectional investigation was performed in an arterial hypertension program of a general hospital. The Spanish version of the Short Form-36 Health Survey and the Spanish version of the Morisky-Green test. The scores of the subscales and Physical Component (PCS) and Mental Component (MCS) summaries of the SF-36 survey were obtained, then the respective bivariate and multivariate analyzes (Poisson regression) were executed. RESULTS 39% of patients had therapeutic adherence. All the dimensions of the SF-36 survey presented a statistical association with adherence to antihypertensive treatment. Poisson regression was executed to identify the independent variables associated with obtaining a score higher than 50 in the PCS [presence of comorbidity (risk factor), work status, and therapeutic adherence (protective factor)] and MCS (therapeutic adherence as a protective factor). CONCLUSIONS Therapeutic adherence, work status, and absence of comorbidity were associated with a better health-related quality of life.
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Affiliation(s)
- Andrea Lozada-Zapata
- AL: MD. Establecimiento de Salud I-3 Salitral, Sub-Región Luciano Castillo Colonna Sullana, Ministerio de Salud del Perú. Piura, Perú. ,
| | - Julio Piscoya
- JP: MD. M. Sc. Medicina. Ph. D. Ciencias Ambientales. Facultad de Ciencias de la Salud, Universidad Nacional de Piura. Piura, Perú.
| | - Carlos Shiraishi-Zapata
- CS: MD. M. Sc. Investigación Clínica. Servicio de Centro Quirúrgico y Anestesiología. Hospital II Talara. Piura, Perú. ,
| | - Wilfredo Mendieta-Albañil
- WM: MD. Servicio de Medicina Interna. Hospital Regional José Cayetano Heredia de Piura. Piura, Perú.
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Avataneo V, Fanelli E, De Nicolò A, Rabbia F, Palermiti A, Pappaccogli M, Cusato J, De Rosa FG, D'Avolio A, Veglio F. A Non-Invasive Method for Detection of Antihypertensive Drugs in Biological Fluids: The Salivary Therapeutic Drug Monitoring. Front Pharmacol 2022; 12:755184. [PMID: 35069191 PMCID: PMC8766966 DOI: 10.3389/fphar.2021.755184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: Arterial hypertension is still the most frequent cause of cardiovascular and cerebrovascular morbidity and mortality. Antihypertensive treatment has proved effective in reduction of cardiovascular risk. Nevertheless, lifestyle interventions and pharmacological therapy in some cases are ineffective in reaching blood pressure target values, despite full dose and poly-pharmacological treatment. Poor adherence to medications is an important cause of treatment failure. Different methods to assess therapeutic adherence are currently available: Therapeutic drug monitoring in biological fluids has previously demonstrated its efficacy and reliability. Plasma and urine have been already used for this purpose, but they may be affected by some practical limitations. Saliva may represent a feasible alternative. Methods: Fourteen antihypertensive drugs and two metabolites were simultaneously tested in plasma, urine, and saliva. Tested molecules included: atenolol, nebivolol, clonidine, ramipril, olmesartan, telmisartan, valsartan, amlodipine, nifedipine, doxazosin, chlorthalidone, hydrochlorothiazide, indapamide, sacubitril, ramiprilat, and sacubitrilat. Therapeutic drug monitoring was performed using ultra-high performance liquid chromatography, coupled to tandem mass spectrometry (UHPLC-MS/MS). The method has been preliminarily evaluated in a cohort of hypertensive patients. Results: The method has been validated according to US Food and Drug Administration (FDA) and European Medicines Agency (EMA) guidelines. The application on a cohort of 32 hypertensive patients has demonstrated sensibility and specificity of 98% and 98.1%, respectively, with a good feasibility in real-life clinical practice. Conclusion: Saliva may represent a feasible biological sample for therapeutic drug monitoring by non-invasive collection, prompt availability, and potential accessibility also in out-of-clinic settings.
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Affiliation(s)
- Valeria Avataneo
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Elvira Fanelli
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, A.O.U. Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Amedeo De Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Franco Rabbia
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, A.O.U. Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Alice Palermiti
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Marco Pappaccogli
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, A.O.U. Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Francesco Giuseppe De Rosa
- Division of Infectious Diseases, Department of Medical Sciences, A.O.U. Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, A.O.U. Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
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Preparation of Antihypertensive Drugs in Biological Matrix with Solvent Front Position Extraction for LC–MS/MS Analysis. Molecules 2021; 27:molecules27010205. [PMID: 35011437 PMCID: PMC8746826 DOI: 10.3390/molecules27010205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Solvent front position extraction procedure was used to prepare biological samples containing selected antihypertensive drugs (ramipril, lercanidipine, indapamide, valsartan, hydrochlorothiazide, perindopril, and nebivolol). Substances separated from the biological matrix components (bovine serum albumin) were quantified by means of liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). Sample preparation process was performed with the use of a prototype horizontal chamber with a moving pipette driven by a 3D printer mechanism enabling a controlled eluent flow velocity. Application of this device was advantageous for simultaneous preparation of several samples for further quantitative analysis, with a synchronized reduction of manual operations and solvent consumption. Quantitative results obtained for the majority of the investigated antihypertensive drugs in a complex biological matrix were satisfactory. The values of the %RSD were around 5% for six of the seven substances (with the exception of indapamide). The method exhibits a suitable accuracy (the relative error percentage was below 10% for most drugs). The values of LOD and LOQ were in the range of 1.19 µg/L–8.53 µg/L and 3.61 µg/L–25.8 µg/L, respectively.
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Zanatta JMDM, Cosenso-Martin LN, da Silva Lopes V, Roma Uyemura JR, Polegati Santos AM, Paz Landim MI, Yugar-Toledo JC, Vilela-Martin JF. Evidence of Nonadherence in Cases of Pseudoresistant Hypertension. Integr Blood Press Control 2021; 14:9-17. [PMID: 33603455 PMCID: PMC7887157 DOI: 10.2147/ibpc.s264057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/26/2020] [Indexed: 11/23/2022] Open
Abstract
Resistant hypertension (RH) is characterized by the use of three or more antihypertensive drugs without reaching the goal of controlling blood pressure (BP). For a definitive diagnosis of RH, it is necessary to exclude causes of pseudoresistance, including the white-coat effect, errors in BP measurement, secondary hypertension, therapeutic inertia, and poor adherence to lifestyle changes and pharmacological treatment. Herein, we report the history of a patient with long-standing uncontrolled BP, even when using seven antihypertensive drugs. Causes of secondary hypertension that justified the high BP levels were investigated, in addition to the other causes of pseudo-RH. In view of the difficult-to-control BP situation, it was decided to hospitalize the patient for better investigation. After 5 days, he had BP control with practically the same medications previously used. Finally, all factors related to the presence of pseudo-RH are discussed, especially poor adherence to treatment. Poor adherence to antihypertensive treatment is common in daily medical practice, and its investigation is of fundamental importance for better management of BP.
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Affiliation(s)
- João Marcos de Menezes Zanatta
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - Luciana Neves Cosenso-Martin
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - Valquíria da Silva Lopes
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - Jéssica Rodrigues Roma Uyemura
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - Aleandra Marton Polegati Santos
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - Manoel Ildefonso Paz Landim
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - Juan Carlos Yugar-Toledo
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - José Fernando Vilela-Martin
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
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Ma G, Luo A, Shen Z, Duan Y, Shi S, Zhong Z. The status of medication literacy and associated factors of hypertensive patients in China: a cross-sectional study. Intern Emerg Med 2020; 15:409-419. [PMID: 31650433 PMCID: PMC7165129 DOI: 10.1007/s11739-019-02187-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/28/2019] [Indexed: 12/23/2022]
Abstract
The adverse consequence of low medication literacy is a major problem that threatens patients' health. The number of people with hypertension is increasing in China. We described the current situation of medication literacy of patients with hypertension in China and its related influencing factor. We conducted a cross-sectional study, which contains 590 hypertensive patients. Stratified sampling was adopted according to the hospital level in China. To determine the factors related to medication literacy, multiple linear regression analysis was used to determine associations between medication literacy of hypertensive patients and other factors. Among 590 respondents, results showed that they have poor medication literacy. Multiple linear regression analysis showed that level of education, annual income, occupation status, and type of medical insurance were significantly associated with medication literacy level of hypertensive patients. In addition, our study also demonstrates that we can identify the medication literacy level of hypertensive patients using the Chinese version Medication Literacy Scale for Hypertensive Patients. High medication literacy is an important factor for hypertensive patients to improve medication adherence, so as to better control blood pressure. We should pay attention to the improvement of medication literacy and take corresponding measures.
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Affiliation(s)
- Guiyue Ma
- grid.216417.70000 0001 0379 7164Third Xiangya Hospital, Central South University, Changsha, 410013 China
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, Changsha, 410013 China
| | - Aijing Luo
- grid.216417.70000 0001 0379 7164Key Laboratory of Medical Information Research, Central South University, College of Hunan Province, Changsha, 410013 China
| | - Zhiying Shen
- grid.216417.70000 0001 0379 7164Third Xiangya Hospital, Central South University, Changsha, 410013 China
| | - Yinglong Duan
- grid.216417.70000 0001 0379 7164Third Xiangya Hospital, Central South University, Changsha, 410013 China
| | - Shuangjiao Shi
- grid.216417.70000 0001 0379 7164Third Xiangya Hospital, Central South University, Changsha, 410013 China
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, Changsha, 410013 China
| | - Zhuqing Zhong
- grid.216417.70000 0001 0379 7164Third Xiangya Hospital, Central South University, Changsha, 410013 China
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, Changsha, 410013 China
- grid.216417.70000 0001 0379 7164Key Laboratory of Medical Information Research, Central South University, College of Hunan Province, Changsha, 410013 China
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Etebari F, Pezeshki MZ, Fakour S. Factors related to the non-adherence of medication and nonpharmacological recommendations in high blood pressure patients. J Cardiovasc Thorac Res 2019; 11:28-34. [PMID: 31024669 PMCID: PMC6477111 DOI: 10.15171/jcvtr.2019.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 02/01/2019] [Indexed: 11/14/2022] Open
Abstract
Introduction: Many studies have been conducted on non-adherence with the antihypertensive treatment regime in various countries, considering the burden of cardiovascular disease (CVD) on the public health system, it is essential to carry out studies in this regard.
Methods: Patients with hypertension evaluated at the family medicine clinic of Tabriz University of Medical Sciences were enrolled using simple sampling. Data gathering tool was a questionnaire consisting of three sections including the Hill-Bone compliance questionnaire, the disease characteristics, and patients’ socioeconomic.
Results: Of 254 patients with hypertension, gender, income satisfaction, the occupation and the level of education did not correlate with the acceptance of the treatment. However, the number of antihypertensive medications had a significant effect on adherence with dietary orders and appointment keeping (P<0.01 and P=0.01, respectively). The number of antihypertensive drugs could statistically significantly predict overall score obtained from the questionnaire, F (1, 251) = 22.29, P<0.018.
Conclusion: Factors related to the history of the disease and socioeconomic status had no effect patients adherence with treatment; however, the number of the prescribed antihypertensive drugs is in association with higher overall scores obtained through the Hill-Bone questionnaire.
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Affiliation(s)
- Farzane Etebari
- Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Sanam Fakour
- Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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A simple UHPLC-PDA method with a fast dilute-and-shot sample preparation for the quantification of canrenone and its prodrug spironolactone in human urine samples. J Pharmacol Toxicol Methods 2018; 94:29-35. [PMID: 30165207 DOI: 10.1016/j.vascn.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/03/2018] [Accepted: 08/22/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Nowadays, the treatment of hypertension represents an important issue, particularly in developed countries. While in most cases the standard therapeutic approaches, consisting in the administration of 1 to 3 drugs, are adequate to reach adequate blood pressure levels, in some cases more drugs are needed: this condition is called "resistant hypertension". In this context, the administration of a diuretic, such as spironolactone or canrenoate salts, represents a standard practice. Since a reliable discrimination of real cases of resistant hypertension from cases of poor therapeutic adherence is currently difficult to obtain, the adoption of therapeutic drug monitoring has been suggested as a useful tool for this purpose. In this work, the authors developed and validated a simple, cheap and fast dilute-and-shot method with UHPLC-PDA analysis for the quantification of spironolactone and its metabolite canrenone in human urine samples. METHODS Standards and quality controls were prepared in urine. Only 100 μL of sample were added with 80 μL of internal standard (6,7-dimethyl-2,3-di(2-pyridyl)quinoxaline) working solution and 820 μL of phosphate buffer 10 mM pH 3.2 (phase A):acetonitrile (phase B) 90:10 v:v solution. Chromatographic separation was performed on an Acquity® UPLC HSS T3 1.8 μm 2.1 × 150 mm column, with a binary gradient for 11 min at 40 °C. RESULTS Accuracy, intra-day and inter-day precision, selectivity and sensitivity fitted FDA guidelines for all analytes (LLOQ and LOD were 156.25 ng/mL and 78.12 ng/mL, respectively, for both analytes) and recovery resulted high and reproducible. Method performances were tested on urine samples from hypertensive patients with good results. DISCUSSION This simple analytical method could represent a useful tool for the management of antihypertensive therapy.
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Avataneo V, De Nicolò A, Rabbia F, Perlo E, Burrello J, Berra E, Pappaccogli M, Cusato J, D'Avolio A, Di Perri G, Veglio F. Therapeutic drug monitoring-guided definition of adherence profiles in resistant hypertension and identification of predictors of poor adherence. Br J Clin Pharmacol 2018; 84:2535-2543. [PMID: 29971815 DOI: 10.1111/bcp.13706] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/01/2018] [Accepted: 06/23/2018] [Indexed: 12/11/2022] Open
Abstract
AIMS Arterial hypertension is an important cardiovascular risk factor. A substantial proportion of patients show resistance to antihypertensive treatment but poor adherence to medication regimens is also a significant cause of treatment failure. In this context, therapeutic drug monitoring (TDM) could be useful. The objective of this study was to assess adherence to treatment in patients with resistant hypertension by TDM and to identify parameters that predict nonadherence. METHODS Liquid chromatography tandem mass spectrometry was used to quantify a wide panel of antihypertensive drugs in human plasma to assess treatment compliance. Associations between TDM-determined adherence profiles, self-reported adherence and other patient-related clinical, anthropometric or demographic features were evaluated as potentially useful pre-TDM predictors of poor adherence. RESULTS TDM was performed on 50 patients with suspected resistant hypertension: 24% of patients partially complied to treatment and 18% were nonadherent. No concordance was observed with questionnaire results, while nonadherence was associated with high diastolic blood pressure, high heart rate, previous onset of stroke and previous use of invasive treatments, including renal denervation or baroreceptor stimulation. CONCLUSIONS This evidence highlights the high prevalence of poor adherence in patients with resistant hypertension and the need for caution in using invasive approaches. These preliminary data require validation in a larger cohort, to confirm the need for TDM in routine clinical practice.
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Affiliation(s)
- Valeria Avataneo
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Amedeo De Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Franco Rabbia
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Elisa Perlo
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Jacopo Burrello
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Elena Berra
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Marco Pappaccogli
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Antonio D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Giovanni Di Perri
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
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Pappaccogli M, Covella M, Berra E, Fulcheri C, Di Monaco S, Perlo E, Burrello J, Monticone S, Rossato D, Rabbia F, Veglio F. Effectiveness of Renal Denervation in Resistant Hypertension: A Meta-Analysis of 11 Controlled Studies. High Blood Press Cardiovasc Prev 2018; 25:167-176. [DOI: 10.1007/s40292-018-0260-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/27/2018] [Indexed: 10/16/2022] Open
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UHPLC-MS/MS method with sample dilution to test therapeutic adherence through quantification of ten antihypertensive drugs in urine samples. J Pharm Biomed Anal 2017; 142:279-285. [PMID: 28538203 DOI: 10.1016/j.jpba.2017.05.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/08/2017] [Indexed: 01/26/2023]
Abstract
Nowadays, hypertension represents an important health problem, particularly in developed countries. In some cases the standard therapeutic approaches are not able to reestablish the normal blood pressure values: this condition is called "resistant hypertension". However, a fraction of cases of resistant hypertension are actually due to poor adherence to the prescribed therapy. Therapeutic Drug Monitoring could represent a direct and useful tool to correctly identify non-compliant patients. Nevertheless, high throughput methods for the simultaneous monitoring of a wide panel of drugs in the same analysis are lacking and, furthermore, there is not a generally acknowledged "standard" matrix for this test (plasma or urine). In this work, we validated a UHPLC-MS/MS assay to quantify ten among the most used antihypertensive agents in urine samples, covering all the current classes: amlodipine, atenolol, clonidine, chlortalidone, doxazosin, hydrochlorothiazide, nifedipine, olmesartan, ramipril and telmisartan. Both standards and quality controls were prepared in urine matrix. Only 100μL of each sample were added with 40μL of internal standard and 860μL of water:acetonitrile 90:10, acidified with 0.05% formic acid. Chromatographic separation was performed on an Acquity® UPLC HSS T3 1.8μm 2.1×150mm column, with a gradient of water and acetonitrile, both added with 0.05% formic acid. Accuracy, intra-day and inter-day precision fitted FDA guidelines for all analytes, while matrix effects resulted reproducible among different urine lots. Method performances were tested on urine samples from hypertensive patients with good results. This simple analytical method could represent a useful tool for the management of antihypertensive therapy.
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