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Filippone EJ, Naccarelli GV, Foy AJ. Controversies in Hypertension V: Resistant and Refractory Hypertension. Am J Med 2024; 137:12-22. [PMID: 37832756 DOI: 10.1016/j.amjmed.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Abstract
Apparent resistant hypertension, defined as uncontrolled office blood pressure despite ≥ 3 antihypertensive medications including a diuretic or use of ≥ 4 medications regardless of blood pressure, occurs in ≤ 15% of treated hypertensives. Apparent refractory hypertension, defined as uncontrolled office pressure despite use of 5 or more medications including a diuretic, occurs in ≤ 10% of resistant cases. Both are associated with increased comorbidity and enhanced cardiovascular risk. To rule out pseudo-resistant or pseudo-refractory hypertension, employ guideline-based methodology for obtaining pressure, maximize the regimen, rule out white-coat effect, and assess adherence. True resistant hypertension is characterized by volume overload and aldosterone excess, refractory by enhanced sympathetic tone. Spironolactone is the preferred agent for resistance, with lower doses. Spironolactone, potassium binders, or both, are preferred if the estimated glomerular filtration rate is below 45. If significant albuminuria, finerenone is indicated. The optimal treatment of refractory hypertension is unclear, but sympathetic inhibition (α-β blockade, centrally acting sympathoinhibitors, or both) seems reasonable. Renal denervation has shown minimal benefit for resistance, but its role in refractory hypertension remains to be defined.
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Affiliation(s)
- Edward J Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa.
| | - Gerald V Naccarelli
- Department of Medicine, Penn State University Heart and Vascular Institute, Penn State M.S. Hershey Medical Center and College of Medicine, Hershey, Pa
| | - Andrew J Foy
- Department of Medicine, Penn State University Heart and Vascular Institute, Penn State M.S. Hershey Medical Center and College of Medicine, Hershey, Pa
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Lane D, Beishon L, Sharma V, Salim F, Sze S, Timmins MA, Robinson T, Eveson D, Mistri A, Patel P, Gupta P. High non-adherence rates to secondary prevention by chemical adherence testing in patients with TIA. J Stroke Cerebrovasc Dis 2022; 31:106665. [PMID: 35901588 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022] Open
Abstract
INTRODUCTION Transient ischaemic attack (TIA) clinics are important for secondary prevention of fatal or disabling stroke. Non-adherence to prescribed medications is an important reason for treatment failure but difficult to diagnose. This study ascertained the utility of a novel biochemical tool in the objective biochemical diagnosis of non-adherence. METHODS One-hundred consecutive urine samples collected from patients attending the TIA clinic, at a tertiary centre, were analysed for presence or absence of prescribed cardiovascular medications using liquid chromatography-mass spectrometry (LC-MS/MS). Patients were classified as adherent or non-adherent, respectively. Demographic and clinical characteristics were compared between the two cohorts. Univariate regression analyses were performed for individual variables and model fitting was undertaken for significant variables. RESULTS The mean duration of follow-up from the index event was 31 days [standard deviation (SD): 18.9]. The overall rate of non-adherence for at least one medication was 24%. In univariate analysis, the number of comorbidities [3.4 (SD: 1.9) vs. 2.5 (1.9), P = 0.032] and total number of all prescribed medications [6.0 (3.3) vs 4.4 (2.1), P = 0.032] were higher in the non-adherent group. On multivariate analysis, the total number of medications prescribed correlated with increased non-adherence (odds ratio: 1.27, 95% Confidence Intervals: 1.1-1.5, P = 0.01). CONCLUSIONS LC-MS/MS is a clinically useful tool for the diagnosis of non-adherence. Nearly a quarter of TIA patients were non-adherent to their cardiovascular medications Addressing non-adherence early may reduce the risk of future disabling cardiovascular events.
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Affiliation(s)
- Dan Lane
- Department of Metabolic Diseases and Chemical Pathology, University Hospitals of Leicester NHS Trust, Level 4, Sandringham Building, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Vinoda Sharma
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom
| | - Farah Salim
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Matthew A Timmins
- Department of Metabolic Diseases and Chemical Pathology, University Hospitals of Leicester NHS Trust, Level 4, Sandringham Building, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
| | - Thompson Robinson
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom; Department of Stroke Medicine, University Hospitals of Leicester NHS Trust, United Kingdom; National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, United Kingdom
| | - David Eveson
- Department of Stroke Medicine, University Hospitals of Leicester NHS Trust, United Kingdom
| | - Amit Mistri
- Department of Stroke Medicine, University Hospitals of Leicester NHS Trust, United Kingdom
| | - Prashanth Patel
- Department of Metabolic Diseases and Chemical Pathology, University Hospitals of Leicester NHS Trust, Level 4, Sandringham Building, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom; Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Pankaj Gupta
- Department of Metabolic Diseases and Chemical Pathology, University Hospitals of Leicester NHS Trust, Level 4, Sandringham Building, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom; Department of Cardiovascular Sciences, University of Leicester, United Kingdom.
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Lane D, Lawson A, Burns A, Azizi M, Burnier M, Jones DJL, Kably B, Khunti K, Kreutz R, Patel P, Persu A, Spiering W, Toennes SW, Tomaszewski M, Williams B, Gupta P, Dasgupta I. Nonadherence in Hypertension: How to Develop and Implement Chemical Adherence Testing. Hypertension 2022; 79:12-23. [PMID: 34739765 DOI: 10.1161/hypertensionaha.121.17596] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Dan Lane
- The Department of Chemical Pathology and Metabolic Diseases, Level 4, Sandringham Building, Leicester Royal Infirmary, United Kingdom (D.L., P.P., P.G.)
- Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, United Kingdom (D.L., K.K.)
| | - Alexander Lawson
- Department of Clinical Chemistry, Immunology and Toxicology, Heartlands Hospital University Hospitals Birmingham, United Kingdom (A.L.)
| | - Angela Burns
- Department of Clinical Biochemistry, Queen Elizabeth University Hospital, Glasgow, United Kingdom (A.B.)
| | - Michel Azizi
- Université de Paris, Inserm CIC1418, Paris, France (M.A.)
- APHP, Hypertension Unit, Hôpital Européen Georges Pompidou, Paris, France (M.A.)
| | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland (M.B.)
| | - Donald J L Jones
- Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom (D.J.L.J., P.P., P.G.)
| | - Benjamin Kably
- Université de Paris, France (B.K.)
- APHP, Pharmacology Unit, Hôpital Européen Georges Pompidou, Paris, France (B.K.)
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, United Kingdom (D.L., K.K.)
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Germany (R.K.)
| | - Prashanth Patel
- The Department of Chemical Pathology and Metabolic Diseases, Level 4, Sandringham Building, Leicester Royal Infirmary, United Kingdom (D.L., P.P., P.G.)
- Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom (D.J.L.J., P.P., P.G.)
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium/Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (A.P.)
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (W.S.)
| | - Stefan W Toennes
- Institute of Legal Medicine, Department of Forensic Toxicology, University Hospital, Goethe University, Frankfurt, Germany (S.W.T.)
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (M.T.)
- Manchester Heart Centre, Manchester University National Health Service Foundation Trust, United Kingdom (M.T.)
| | - Bryan Williams
- Department of Cardiovascular Sciences, University College London, United Kingdom (B.W.)
| | - Pankaj Gupta
- The Department of Chemical Pathology and Metabolic Diseases, Level 4, Sandringham Building, Leicester Royal Infirmary, United Kingdom (D.L., P.P., P.G.)
- Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom (D.J.L.J., P.P., P.G.)
| | - Indranil Dasgupta
- Renal Unit, Heartlands Hospital, Birmingham and Warwick Medical School, University of Warwick, Coventry, United Kingdom (I.D.)
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Monitoring Antihypertensive Medication Adherence by LC-MS/MS: Method Establishment and Clinical Application. J Cardiovasc Pharmacol 2021; 78:581-596. [PMID: 34269698 DOI: 10.1097/fjc.0000000000001105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/26/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Proper medication compliance is critical for the integrity of clinical practice, directly related to the success of clinical trials to evaluate both pharmacological and device-based therapies. Here, we established a liquid chromatography tandem mass spectrometry (LC-MS/MS) method to accurately detect 55 chemical entities in human urine sample, which accounting for the most commonly used 172 antihypertensive drugs in China. The established method had good accuracy, intra-day and inter-day precision for all analyses in both bench tests and validated in 21 hospitalized patients. We utilized this method to monitor and ensure drug compliance, and exclude the inferring impacts of medication compliance as a key confounder for our pivotal trial of a catheter-based, renal mapping and selective renal denervation to treat hypertension. It is found that in the urine samples from 92 consecutive subjects, 85 subjects (92.4%) were consistent with their prescriptions after 28 days run-in periods, 90 (97.8%) and 85 (95.5%) patients completely complied with their medications during the 3-month and 6-month follow-up period, respectively. Thus, using LC-MS/MS method with specificity, accuracy and precision, we ensured drug compliance of patients, excluded the key confounder of drug interferences and ensured the quality of our device-based clinical trial for treatment of hypertension.
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Schäfer AK, Kuczera T, Wurm-Kuczera R, Müller D, Born E, Lipphardt M, Plüss M, Wallbach M, Koziolek M. Eligibility for Baroreflex Activation Therapy and medication adherence in patients with apparently resistant hypertension. J Clin Hypertens (Greenwich) 2021; 23:1363-1371. [PMID: 34101968 PMCID: PMC8678808 DOI: 10.1111/jch.14302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/30/2021] [Accepted: 05/16/2021] [Indexed: 12/29/2022]
Abstract
Uncontrolled hypertension is a main risk factor for cardiovascular morbidity. Baroreflex activation therapy (BAT) is an effective therapy option addressing true resistant hypertension. We evaluated patients’ eligibility for BAT in a staged assessment as well as adherence to antihypertensive drug therapy. Therefore, we analyzed files of 345 patients, attending the hypertension clinic at University Medicine Göttingen. Additionally, gas chromatographic‐mass spectrometric urine analyses of selected individuals were performed evaluating their adherence. Most common cause for a revoked BAT recommendation was blood pressure (BP) control by drug adjustment (54.2%). Second leading cause was presence of secondary hypertension (31.6%). Patients to whom BAT was recommended (59 (17.1%)) were significantly more often male (67.8% vs. 43.3%, P = .0063), had a higher body mass index (31.8 ± 5.8 vs. 30.0 ± 5.7 kg/m², P = .0436), a higher systolic office (168.7 ± 24.7 vs. 147.7 ± 24.1 mmHg, P < .0001), and 24h ambulatory BP (155.0 ± 14.6 vs. 144.4 ± 16.8 mmHg, P = .0031), took more antihypertensive drugs (5.8 ± 1.3 vs. 4.4 ± 1.4, P < .0001), and suffered more often from numerous concomitant diseases. Eventually, 27 (7.8%) received a BAT system. In the toxicological analysis of 75 patients, mean adherence was 75.1%. 16 patients (21.3%) showed non‐adherence. Thus, only a small number of patients eventually received a BAT system, as treatable reasons for apparently resistant hypertension could be identified frequently. This study is—to our knowledge—the first report of a staged assessment of patients’ suitability for BAT and underlines the need for a careful examination and indication. Non‐adherence was proven to be a relevant issue concerning apparently resistant hypertension and therefore non‐eligibility for interventional antihypertensive therapy. We evaluated the eligibility for baroreflex activation therapy (BAT) of 345 patients, attending the hypertension clinic at University Medicine Göttingen. Patients’ drug adherence was investigated by 75 toxicological analyses. Most common cause for a revoked BAT recommendation was blood pressure control by drug adjustment. Eventually, only less patients (7.8%) received a BAT system. Patients receiving a BAT recommendation showed specific characteristics and suffered numerous comorbidities, leading to a high cardiovascular risk, and therefore seem to greatly benefit from BAT implantation. 21.3% of patients showed non‐adherence, proving non‐adherence to be a relevant issue.
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Affiliation(s)
- Ann-Kathrin Schäfer
- Department of Nephrology & Rheumatology, University Medical Centre, Göttingen, Germany
| | - Tim Kuczera
- Department of Nephrology & Rheumatology, University Medical Centre, Göttingen, Germany
| | - Rebecca Wurm-Kuczera
- Department of Hematology & Oncology, University Medical Centre, Göttingen, Germany
| | | | - Ellen Born
- Department of Nephrology & Rheumatology, University Medical Centre, Göttingen, Germany
| | - Mark Lipphardt
- Department of Nephrology & Rheumatology, University Medical Centre, Göttingen, Germany
| | - Marlene Plüss
- Department of Nephrology & Rheumatology, University Medical Centre, Göttingen, Germany
| | - Manuel Wallbach
- Department of Nephrology & Rheumatology, University Medical Centre, Göttingen, Germany
| | - Michael Koziolek
- Department of Nephrology & Rheumatology, University Medical Centre, Göttingen, Germany
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6
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Abstract
: Suboptimal adherence to antihypertensive medication is a major contributor to poor blood pressure control. Several methods, direct or indirect, are available for measuring adherence, including the recently developed biochemical screening, although there is no gold-standard method routinely used in clinical practice to accurately assess the different facets of adherence. Adherence to treatment is a complex phenomenon and several of the barriers to adherence will need to be addressed at the healthcare system level; however, when looking at adherence from a more practical side and from the practitioner's perspective, the patient-practitioner relationship is a key element both in detecting adherence and in attempting to choose interventions tailored to the patient's profile. The use of single-pill combinations enabling simplification of treatment regimen, the implementation of a collaborative team-based approach and the development of electronic health tools also hold promise for improving adherence, and thus impacting cardiovascular outcomes and healthcare costs.
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7
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Rognstad S, Søraas CL, Bergland OU, Høieggen A, Strømmen M, Helland A, Opdal MS. Establishing Serum Reference Ranges for Antihypertensive Drugs. Ther Drug Monit 2021; 43:116-125. [PMID: 32881780 DOI: 10.1097/ftd.0000000000000806] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) involves the measurement of serum drug concentrations to optimize pharmacotherapy. Traditionally, blood pressure measurements alone, and not TDM, have been used to evaluate the antihypertensive drug response. However, approximately 50% of hypertensive patients treated with lifestyle changes and antihypertensive drugs fail to achieve blood pressure control. Serum drug concentration measurements could be useful to select the optimal drugs in adjusted doses and to identify nonadherence. Implementation of TDM in clinical routine for antihypertensive drugs depends on established serum reference ranges. METHODS Commonly used antihypertensive drugs were identified based on prescription data. The authors performed a review of authoritative literature on reported serum drug concentrations and calculated expected concentrations from previously reported pharmacokinetic parameters with commonly prescribed daily doses. Finally, serum drug concentrations in samples from patients undergoing antihypertensive treatment were measured. RESULTS Serum reference ranges for 24 frequently used antihypertensive drugs were established based on results from 3 approaches. CONCLUSIONS Serum drug concentration measurements, interpreted in light of the established reference ranges, together with blood pressure measurements and other clinical data, may help identify nonadherent patients and tailor individual antihypertensive treatment when deviant drug responses appear in line with the concept of personalized medicine.
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Affiliation(s)
- Stine Rognstad
- Department of Pharmacology, Oslo University Hospital
- Institute of Clinical Medicine, University of Oslo
- Section of Cardiovascular and Renal Research, Oslo University Hospital
| | - Camilla L Søraas
- Section of Cardiovascular and Renal Research, Oslo University Hospital
- Unit of Environmental and Occupational Medicine, Oslo University Hospital
| | - Ola U Bergland
- Institute of Clinical Medicine, University of Oslo
- Section of Cardiovascular and Renal Research, Oslo University Hospital
| | - Aud Høieggen
- Institute of Clinical Medicine, University of Oslo
- Section of Cardiovascular and Renal Research, Oslo University Hospital
- Department of Nephrology, Oslo University Hospital, Ullevål
| | - Magnus Strømmen
- Department of Surgery, Center for Obesity Research, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology
| | - Arne Helland
- Department of Clinical Pharmacology, St. Olavs University Hospital; and
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mimi S Opdal
- Department of Pharmacology, Oslo University Hospital
- Institute of Clinical Medicine, University of Oslo
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Undrum Bergland O, Larstorp ACK, Lund Søraas C, Høieggen A, Rostrup M, Norheim Kjaer V, Godang K, Sevre K, Fadl Elmula FEM. Changes in sympathetic nervous system activity after renal denervation: results from the randomised Oslo RDN study. Blood Press 2021; 30:154-164. [PMID: 33399016 DOI: 10.1080/08037051.2020.1868286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Sympathetic nervous system (SNS) over-activity is associated with essential hypertension. Renal sympathetic denervation (RDN) possibly lowers office- and ambulatory blood pressure (BP) in patients with treatment-resistant hypertension (TRH). We aimed to assess the effect of RDN compared to drug adjustment on SNS activity among patients with TRH by measuring plasma catecholamines and heart rate variability (HRV) during stress tests. MATERIALS AND METHODS Patients with TRH were randomised to RDN (n = 9) or Drug Adjustment (DA) (n = 10). We measured continuous HRV and beat-to-beat-BP using FinaPres® and obtained plasma catecholamines during standardised orthostatic- and cold-pressor stress tests (CPT) before- and six months after randomisation. RESULTS CPT revealed no differences between groups at baseline in peak adrenaline concentration (69.3 pg/mL in the DA group vs. 70.0 pg/mL in the RDN group, p = 0.38) or adrenaline reactivity (Δ23.1 pg/mL in the DA group vs. Δ29.3 pg/mL in the RDN group, p = 0.40). After six months, adrenaline concentrations were statistically different between groups after one minute (66.9 pg/mL in the DA group vs. 55.3 pg/mL in the RDN group, p = 0.03), and six minutes (62.4 pg/mL in the DA group vs. 50.1 pg/mL in the RDN group, p = 0.03). There was a tendency of reduction in adrenaline reactivity after six months in the RDN group (Δ26.3 pg/mL at baseline vs. Δ12.8 pg/ml after six months, p = 0.08), while it increased in the DA group (Δ13.6 pg/mL at baseline vs. Δ19.9 pg/mL after six months, p = 0.53). We also found a difference in the Low Frequency band at baseline following the CPT (667µs2 in the DA group vs. 1628µs2 in the RDN group, p = 0.03) with a clear tendency of reduction in the RDN group to 743µs2 after six months (p = 0.07), compared to no change in the DA group (1052µs2, p = 0.39). CONCLUSION Our data suggest that RDN reduces SNS activity after six months. This finding warrants investigation in a larger study. Clinical Trial Number registered at www.clinicaltrials.gov: NCT01673516.
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Affiliation(s)
- Ola Undrum Bergland
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital Ullevål, Oslo, Norway
| | - Camilla Lund Søraas
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Section for Environmental and Occupational Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Aud Høieggen
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Morten Rostrup
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Vibeke Norheim Kjaer
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Knut Sevre
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Fadl Elmula M Fadl Elmula
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital Ullevål, Oslo, Norway
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Kably B, Billaud EM, Boutouyrie P, Azizi M. Is there any Hope for Monitoring Adherence in an Efficient and Feasible Way for Resistant Hypertension Diagnosis and Follow-Up? Curr Hypertens Rep 2020; 22:96. [PMID: 33052474 DOI: 10.1007/s11906-020-01105-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Non-adherence to antihypertensive treatment is highly prevalent and represents a major factor affecting their effectiveness in hypertensive patients, thus contributing to apparent treatment resistance. It is however often overlooked because the methods to assess non-adherence are mainly subjective, limiting their usefulness in clinical practice. Non-adherence to treatment affects daily patient management, resulting in inappropriate, costly, and potentially harmful treatments and loss of the expected benefits from antihypertensive drugs. RECENT FINDINGS Specialized centers now use a combination of objective screening tools. Firstly, snapshots of adherence levels can be provided by analytical drug detection in various biological matrixes using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and secondly electronic monitoring systems of drug delivery which provide longitudinal data on adherence. Routine utilization of those tools allows the detection of non-adherence in patients with resistant hypertension, thus enabling implementation of appropriate interventions to improve drug adherence and avoid unnecessary treatment intensification. Other complementary techniques, such as digital health feedback system with ingestible sensors, are currently evaluated. In the context of an increasing burden of uncontrolled and apparent treatment-resistant hypertension, detecting non-adherence to antihypertensive therapy is, as acknowledged by the latest guidelines, a top priority to implement in clinical practice but still faces medical conservatism and disbelief.
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Affiliation(s)
- Benjamin Kably
- Université de Paris, F-75006, Paris, France
- Pharmacology Unit, AP-HP, Hôpital Européen Georges Pompidou, F-75015, Paris, France
- Inserm U970, Paris Centre de Recherche Cardiovasculaire-PARCC, F-75015, Paris, France
| | - Eliane M Billaud
- Pharmacology Unit, AP-HP, Hôpital Européen Georges Pompidou, F-75015, Paris, France
- Inserm U970, Paris Centre de Recherche Cardiovasculaire-PARCC, F-75015, Paris, France
| | - Pierre Boutouyrie
- Université de Paris, F-75006, Paris, France
- Pharmacology Unit, AP-HP, Hôpital Européen Georges Pompidou, F-75015, Paris, France
- Inserm U970, Paris Centre de Recherche Cardiovasculaire-PARCC, F-75015, Paris, France
| | - Michel Azizi
- Université de Paris, F-75006, Paris, France.
- Hypertension Unit, DMU CARTE, AP-HP, Hôpital Européen Georges Pompidou, F-75015, Paris, France.
- Inserm, CIC 1418, F-75015, Paris, France.
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Lauder L, Ewen S, Kunz M, Richter LHJ, Jacobs CM, Kindermann I, Böhm M, Meyer MR, Mahfoud F. Adherence to Antihypertensive Drugs Assessed by Hyphenated High-Resolution Mass Spectrometry Analysis of Oral Fluids. J Am Heart Assoc 2020; 9:e014180. [PMID: 32633188 PMCID: PMC7660713 DOI: 10.1161/jaha.119.014180] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background It is currently unknown if antihypertensive drugs can be monitored in oral fluid (OF) using liquid chromatography coupled to high‐resolution mass spectrometry. Methods and Results We assessed adherence using liquid chromatography coupled to high‐resolution mass spectrometry in OF, plasma, and urine of 56 consecutive patients with hypertension referred to a tertiary hypertension unit. Of these patients, 59% were completely adherent (all drugs detectable in urine), whereas 29% and 13% were partially adherent (1 drug not detectable in urine) or nonadherent (>1 drug not detectable in urine), respectively. Adherent patients were on fewer antihypertensive drugs (P=0.001), had fewer daily drug doses (P=0.012), and had lower 24‐hour ambulatory systolic (P=0.012) and diastolic (P=0.009) blood pressures than nonadherent or partially adherent patients. Most drugs were detected in urine compared with plasma and OF (181 versus 119 versus 88; P=0.001). Compared with urine and plasma, detection rates of angiotensin‐converting enzyme inhibitors, angiotensin II receptor blockers, and diuretics were lower in OF. There was no difference in the frequency of detecting β blockers (P=1.0) and calcium channel blockers (P=0.063) when comparing OF with urine. There was no difference in the number of calcium channel blockers (P=0.727), β blockers (P=1.000), thiazide diuretics (P=0.125), and α‐2 agonists (P=0.125) identified between OF and plasma. Conclusions This study shows the feasibility of drug adherence testing for several antihypertensive drugs, especially those without acidic components, in OF, with a similar recovery compared with plasma. Therefore, drug adherence testing in OF should be further explored as a noninvasive approach, which can easily be performed in an “out‐of‐office” setting.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Universitätsklinikum des Saarlandes and Saarland University Homburg/Saar Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Universitätsklinikum des Saarlandes and Saarland University Homburg/Saar Germany
| | - Michael Kunz
- Klinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Universitätsklinikum des Saarlandes and Saarland University Homburg/Saar Germany
| | - Lilian H J Richter
- Department of Experimental and Clinical Toxicology Institute of Experimental and Clinical Pharmacology and Toxicology Center for Molecular Signaling Saarland University Homburg/Saar Germany
| | - Cathy M Jacobs
- Department of Experimental and Clinical Toxicology Institute of Experimental and Clinical Pharmacology and Toxicology Center for Molecular Signaling Saarland University Homburg/Saar Germany
| | - Ingrid Kindermann
- Klinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Universitätsklinikum des Saarlandes and Saarland University Homburg/Saar Germany
| | - Michael Böhm
- Klinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Universitätsklinikum des Saarlandes and Saarland University Homburg/Saar Germany
| | - Markus R Meyer
- Department of Experimental and Clinical Toxicology Institute of Experimental and Clinical Pharmacology and Toxicology Center for Molecular Signaling Saarland University Homburg/Saar Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Universitätsklinikum des Saarlandes and Saarland University Homburg/Saar Germany.,Institute for Medical Engineering and Science MIT Cambridge MA
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11
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Tanna S, Ogwu J, Lawson G. Hyphenated mass spectrometry techniques for assessing medication adherence: advantages, challenges, clinical applications and future perspectives. ACTA ACUST UNITED AC 2020; 58:643-663. [DOI: 10.1515/cclm-2019-0820] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/19/2019] [Indexed: 11/15/2022]
Abstract
AbstractNonadherence to prescribed pharmacotherapy is an understated public health problem globally and is costing many patients their chance to return to good health and healthcare systems billions. Clinicians need an accurate assessment of adherence to medications to aid the clinical decision-making process in the event of poor patient progress and to maximise the patient health outcomes from the drug therapies prescribed. An overview of indirect and direct methods used to measure medication adherence is presented, highlighting the potential for accurate measuring of drugs in biological samples using hyphenated mass spectrometry (MS) techniques to provide healthcare professionals with a reliable evidence base for clinical decision making. In this review we summarise published applications of hyphenated MS techniques for a diverse range of clinical areas demonstrating the rise in the use of such direct methods for assessing medication adherence. Although liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods using plasma, serum and urine samples are the most popular, in recent years increased attention has been given to liquid chromatography high-resolution mass spectrometry (LC-HRMS) methods and alternative biosample matrices including hair, saliva and blood microsamples. The advantages and challenges of using hyphenated MS techniques to address this healthcare problem are also discussed alongside future perspectives.
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Affiliation(s)
- Sangeeta Tanna
- Leicester School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - John Ogwu
- Leicester School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Graham Lawson
- Leicester School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
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12
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Lamirault G, Artifoni M, Daniel M, Barber-Chamoux N, Nantes University Hospital Working Group On Hypertension. Resistant Hypertension: Novel Insights. Curr Hypertens Rev 2019; 16:61-72. [PMID: 31622203 DOI: 10.2174/1573402115666191011111402] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 12/27/2022]
Abstract
Hypertension is the most common chronic disease and the leading risk factor for disability and premature deaths in the world, accounting for more than 9 million deaths annually. Resistant hypertension is a particularly severe form of hypertension. It was described 50 years ago and since then has been a very active field of research. This review aims at summarizing the most recent findings on resistant hypertension. The recent concepts of apparent- and true-resistant hypertension have stimulated a more precise definition of resistant hypertension taking into account not only the accuracy of blood pressure measurement and pharmacological class of prescribed drugs but also patient adherence to drugs and life-style recommendations. Recent epidemiological studies have reported a 10% prevalence of resistant hypertension among hypertensive subjects and demonstrated the high cardiovascular risk of these patients. In addition, these studies identified subgroups of patients with even higher morbidity and mortality risk, probably requiring a more aggressive medical management. In the meantime, guidelines provided more standardized clinical work-up to identify potentially reversible causes for resistant hypertension such as secondary hypertension. The debate is however still ongoing on which would be the optimal method(s) to screen for non-adherence to hypertension therapy, recognized as the major cause for (pseudo)-resistance to treatment. Recent randomized clinical trials have demonstrated the strong benefit of anti-aldosterone drugs (mostly spironolocatone) as fourth-line therapies in resistant hypertension whereas clinical trials with device-based therapies displayed contrasting results. New trials with improved devices and more carefully selected patients with resistant hypertension are ongoing.
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Affiliation(s)
- Guillaume Lamirault
- l'institut du Thorax, INSERM, CNRS, UNIV Nantes, Nantes, France.,l'institut du Thorax, CHU Nantes, Service de Cardiologie, Nantes, France
| | | | - Mélanie Daniel
- Clinical Pharmacology Centre (INSERM CIC1505), CHU Clermont-Ferrand, France
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Punt AM, Stienstra NA, van Kleef MEA, Lafeber M, Spiering W, Blankestijn PJ, Bots ML, van Maarseveen EM. Screening of cardiovascular agents in plasma with LC-MS/MS: A valuable tool for objective drug adherence assessment. J Chromatogr B Analyt Technol Biomed Life Sci 2019; 1121:103-110. [PMID: 31146083 DOI: 10.1016/j.jchromb.2019.05.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/07/2019] [Accepted: 05/12/2019] [Indexed: 11/30/2022]
Abstract
Adherence to cardiovascular preventive agents is important to prevent short and long term cardiovascular events. Recently, qualitatively compound screening using liquid chromatography-tandem mass spectrometry (LC-MS/MS) has gained interest for drug adherence assessment in patients at high risk of cardiovascular events. Therefore, we developed and tested an assay including 52 compounds and metabolites, covering over 95% of the antihypertensive and antithrombotic agents available worldwide. Trichloroacetic acid was used as simple and fast method for protein precipitation. The assay was validated for lower limit of quantification (LLOQ), linearity, stability for freeze/thaw, room temperature, autosampler and matrix effects. The LLOQ for each compound was targeted under the population trough concentration (PTC) as reported in literature to assure high sensitivity for adherence detection. This was accomplished for 50 of 52 compounds with a LLOQ equal or lower compared to the PTC. Linearity was confirmed for all compounds (r2 > 0.995), except for acetylsalicylic acid (r2 = 0.991). For room temperature stability, 12 compounds showed degradation over 20% after 20 h. 3 compounds suffer from matrix effect with recoveries < 50%. After analytical validation, blood samples from 91 patients with difficult-to-treat hypertension were analyzed. Patients were unaware of adherence assessment. Adherence varied largely per agent and per concentration ratio (CR) (ratio of the detected concentration with LC-MS/MS and the PTC) cut-off value. Additionally, stratification by adherence group showed that the percentage of patients classified as non-adherent increased from 6.6% for qualitative analysis (pos/neg) to 19.8% for a CR cut-off of 0.5. The data imply that using the CR cut off values has a significant and relevant effect on patient adherence classification.
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Affiliation(s)
- A M Punt
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, Netherlands.
| | - N A Stienstra
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, Netherlands
| | - M E A van Kleef
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - M Lafeber
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - W Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - P J Blankestijn
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| | - M L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - E M van Maarseveen
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, Netherlands
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14
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Wunder C, Persu A, Lengelé JP, Mg Georges C, Renkin J, Pasquet A, Carlier M, Zhang ZY, Staessen JA. Adherence to antihypertensive drug treatment in patients with apparently treatment-resistant hypertension in the INSPiRED pilot study. Blood Press 2019; 28:168-172. [PMID: 30942111 DOI: 10.1080/08037051.2019.1599814] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Drug adherence may be a major problem in the therapy of hypertension and in the diagnosis of therapy resistance. Adherence can be assessed by indirect methods or by direct methods like drug detection in urine with liquid chromatography-mass spectrometric methods. MATERIALS AND METHODS The current analysis included patients with apparently treatment- resistant hypertension (TRH) referred for renal denervation (RDN) and included in the the INSPiRED pilot trial (NCT01505010). Adherence was repeatedly assessed by toxicological urine analysis over a time range of up to 17 months in a total of 18 patients. RESULTS In the first urine samples of 18 patients the adherence rate (percentage of number of detected vs. prescribed medical drugs) ranged from 0 to 100% with a median of 73.2%. In further urine samples collected during the following up to 17 months every individual patient exhibited considerable changes in the adherence rate, neither a constancy nor a tendency could be deduced. CONCLUSIONS Urine analysis results exhibit variation over time and an assessment at a certain time point cannot be regarded as representative or predictor for future behavior. Therefore, it appears necessary to perform drug adherence testing repeatedly over time.
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Affiliation(s)
- Cora Wunder
- a Institute of Legal Medicine, Goethe-University Frankfurt , Frankfurt , Germany
| | - Alexandre Persu
- b Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium.,c Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique , Université Catholique de Louvain , Brussels , Belgium
| | - Jean-Philippe Lengelé
- b Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium.,d Department of Nephrology , Grand Hôpital de Charleroi , Gilly , Belgium
| | - Coralie Mg Georges
- b Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Jean Renkin
- b Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium.,c Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique , Université Catholique de Louvain , Brussels , Belgium
| | - Agnès Pasquet
- b Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Marc Carlier
- e Department of Cardiology , Grand Hôpital de Charleroi , Gilly , Belgium
| | - Zhen-Yu Zhang
- f Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium
| | - Jan A Staessen
- f Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium.,g Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , The Netherlands
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- a Institute of Legal Medicine, Goethe-University Frankfurt , Frankfurt , Germany
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15
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Burns AD, Lane D, Cole R, Patel P, Gupta P. Cardiovascular Medication Stability in Urine for Non-Adherence Screening by LC–MS-MS. J Anal Toxicol 2018; 43:325-329. [DOI: 10.1093/jat/bky090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/21/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- A D Burns
- Department of Chemical Pathology and Metabolic Diseases, Level 4, Sandringham Building, Leicester Royal Infirmary, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - D Lane
- Department of Chemical Pathology and Metabolic Diseases, Level 4, Sandringham Building, Leicester Royal Infirmary, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - P Patel
- Department of Chemical Pathology and Metabolic Diseases, Level 4, Sandringham Building, Leicester Royal Infirmary, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - P Gupta
- Department of Chemical Pathology and Metabolic Diseases, Level 4, Sandringham Building, Leicester Royal Infirmary, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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16
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Egan BM, Rudisill C. Cost-Utility of an Objective Biochemical Measure to Improve Adherence to Antihypertensive Treatment. Hypertension 2018; 72:1090-1092. [PMID: 30354834 DOI: 10.1161/hypertensionaha.118.11301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brent M Egan
- From the Department of Medicine, University of South Carolina School of Medicine, Greenville (B.M.E.).,Care Coordination Institute, Greenville, SC (B.M.E., C.R.)
| | - Caroline Rudisill
- Care Coordination Institute, Greenville, SC (B.M.E., C.R.).,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Greenville (C.R.)
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17
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18
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19
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George MJ, Marks DJB, Rezk T, Breckenridge R, Sofat R, Martin J, MacAllister R, Touyz RM, Staessen JA, Bursztyn M, Lappin D, Barigou M, Hingorani A. Resistant Hypertension: Trials and Tribulations. Hypertension 2018; 71:772-780. [PMID: 29610269 DOI: 10.1161/hypertensionaha.118.10864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marc J George
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Daniel J B Marks
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Tamer Rezk
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Ross Breckenridge
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Reecha Sofat
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - John Martin
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Raymond MacAllister
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Rhian M Touyz
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Jan A Staessen
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Michael Bursztyn
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - David Lappin
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Mohammed Barigou
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
| | - Aroon Hingorani
- From the Department of Clinical Pharmacology, University College London Hospital NHS Foundation Trust, United Kingdom (M.J.G., R.S., J.M., A.H.); Centre for Molecular Medicine, University College London, United Kingdom (D.J.B.M.); Nephrology, Royal Free London NHS Foundation Trust, United Kingdom (T.R.); Silver Creek Pharmaceuticals, San Francisco, CA (R.B.); Dorset County Hospital, Dorchester, United Kingdom (R.M.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (R.M.T.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S.); Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel (M.B.); Department of Nephrology, Galway University Hospitals, Ireland (D.L.); and University Paris Descartes, AP-HP, Hypertension Unit, Hospital European Georges Pompidou, France (M.B.)
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Gupta P, Patel P, Štrauch B, Lai FY, Akbarov A, Gulsin GS, Beech A, Marešová V, Topham PS, Stanley A, Thurston H, Smith PR, Horne R, Widimský J, Keavney B, Heagerty A, Samani NJ, Williams B, Tomaszewski M. Biochemical Screening for Nonadherence Is Associated With Blood Pressure Reduction and Improvement in Adherence. Hypertension 2017; 70:1042-1048. [PMID: 28847892 PMCID: PMC5642335 DOI: 10.1161/hypertensionaha.117.09631] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 05/10/2017] [Accepted: 07/17/2017] [Indexed: 12/24/2022]
Abstract
We hypothesized that screening for nonadherence to antihypertensive treatment using liquid chromatography-tandem mass spectrometry-based biochemical analysis of urine/serum has therapeutic applications in nonadherent hypertensive patients. A retrospective analysis of hypertensive patients attending specialist tertiary care centers was conducted in 2 European countries (United Kingdom and Czech Republic). Nonadherence to antihypertensive treatment was diagnosed using biochemical analysis of urine (United Kingdom) or serum (Czech Republic). These results were subsequently discussed with each patient, and data on follow-up clinic blood pressure (BP) measurements were collected from clinical files. Of 238 UK patients who underwent biochemical urine analysis, 73 were nonadherent to antihypertensive treatment. Their initial urinary adherence ratio (the ratio of detected to prescribed antihypertensive medications) increased from 0.33 (0-0.67) to 1 (0.67-1) between the first and the last clinic appointments. The observed increase in the urinary adherence ratio in initially nonadherent UK patients was associated with the improved BP control; by the last clinic appointment, systolic and diastolic BPs were ≈19.5 and 7.5 mm Hg lower than at baseline (P=0.001 and 0.009, respectively). These findings were further corroborated in 93 nonadherent hypertensive patients from Czech Republic-their average systolic and diastolic BPs dropped by ≈32.6 and 17.4 mm Hg, respectively (P<0.001), on appointments after the biochemical analysis. Our data show that nonadherent hypertensive patients respond to liquid chromatography-tandem mass spectrometry-based biochemical analysis with improved adherence and significant BP drop. Such repeated biochemical analyses should be considered as a therapeutic approach in nonadherent hypertensive patients.
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Affiliation(s)
- Pankaj Gupta
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Prashanth Patel
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Branislav Štrauch
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Florence Y Lai
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Artur Akbarov
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Gaurav S Gulsin
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Alison Beech
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Věra Marešová
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Peter S Topham
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Adrian Stanley
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Herbert Thurston
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Paul R Smith
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Robert Horne
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Jiří Widimský
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Bernard Keavney
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Anthony Heagerty
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Nilesh J Samani
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Bryan Williams
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.)
| | - Maciej Tomaszewski
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., G.S.G., P.R.S.); Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P., F.Y.L., G.S.G., N.J.S.); National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, United Kingdom (P.G., P.P., F.Y.L., N.J.S.); Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (P.G., A.A., B.K., A.H., M.T.); 3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre (B.S., J.W.) and Institute of Forensic Medicine and Toxicology (V.M.), General University Hospital, Charles University, Prague, Czech Republic; University of Leicester, United Kingdom (A.B.); University Hospitals of Leicester NHS Trust, United Kingdom (P.S.T., A.S., H.T.); Department of Health Psychology, University College of London, United Kingdom (R.H.); Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (B.K., A.H., M.T.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); and National Institute for Health Research, University College London Hospitals Biomedical Research Centre, United Kingdom (B.W.).
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“The final arbiter of everything”: a genealogy of concern with patient experience in Britain. SOCIAL THEORY & HEALTH 2017. [DOI: 10.1057/s41285-017-0045-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gupta P, Patel P, Štrauch B, Lai FY, Akbarov A, Marešová V, White CM, Petrák O, Gulsin GS, Patel V, Rosa J, Cole R, Zelinka T, Holaj R, Kinnell A, Smith PR, Thompson JR, Squire I, Widimský J, Samani NJ, Williams B, Tomaszewski M. Risk Factors for Nonadherence to Antihypertensive Treatment. Hypertension 2017; 69:1113-1120. [DOI: 10.1161/hypertensionaha.116.08729] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 11/28/2016] [Accepted: 03/01/2017] [Indexed: 01/06/2023]
Abstract
Nonadherence to antihypertensive treatment is a critical contributor to suboptimal blood pressure control. There are limited and heterogeneous data on the risk factors for nonadherence because few studies used objective-direct diagnostic methods. We used high-performance liquid chromatography-tandem mass spectrometry of urine and serum to detect nonadherence and explored its association with the main demographic- and therapy-related factors in 1348 patients with hypertension from 2 European countries. The rates of nonadherence to antihypertensive treatment were 41.6% and 31.5% in the UK and Czech populations, respectively. Nonadherence was inversely related to age and male sex. Each increase in the number of antihypertensive medications led to 85% and 77% increase in nonadherence (
P
<0.001) in the UK and Czech populations, respectively. The odds of nonadherence to diuretics were the highest among 5 classes of antihypertensive medications (
P
≤0.005 in both populations). The predictive model for nonadherence, including age, sex, diuretics, and the number of prescribed antihypertensives, showed area under the curves of 0.758 and 0.710 in the UK and Czech populations, respectively. The area under the curves for the UK model tested on the Czech data and for the Czech model tested on UK data were calculated at 0.708 and 0.756, respectively. We demonstrate that the number and class of prescribed antihypertensives are modifiable risk factors for biochemically confirmed nonadherence to blood pressure–lowering therapy. Further development of discriminatory models incorporating these parameters might prove clinically useful in assessment of nonadherence in countries where biochemical analysis is unavailable.
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Affiliation(s)
- Pankaj Gupta
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Prashanth Patel
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Branislav Štrauch
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Florence Y. Lai
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Artur Akbarov
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Věra Marešová
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Christobelle M.J. White
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Ondřej Petrák
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Gaurav S. Gulsin
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Veena Patel
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Ján Rosa
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Richard Cole
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Tomáš Zelinka
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Robert Holaj
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Angela Kinnell
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Paul R. Smith
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - John R. Thompson
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Iain Squire
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Jiří Widimský
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Nilesh J. Samani
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Bryan Williams
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
| | - Maciej Tomaszewski
- From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health
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23
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de Leeuw PW, Bisognano JD, Bakris GL, Nadim MK, Haller H, Kroon AA. Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy: Results of the 6-Year Open Follow-Up. Hypertension 2017; 69:836-843. [PMID: 28320856 DOI: 10.1161/hypertensionaha.117.09086] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 01/25/2017] [Accepted: 01/31/2017] [Indexed: 12/21/2022]
Abstract
Baroreflex activation therapy is a novel technique for treating patients with resistant hypertension. Although short-term studies have demonstrated that it lowers blood pressure, long-term results have not yet been reported. The aim of the present study is to assess the long-term efficacy and safety of baroreflex activation therapy. Long-term follow-up data were analyzed from all patients who had been included in 1 of the 3 trials that focused on treatment-resistant hypertensive patients. Altogether, 383 patients were available for analysis: 143 of these had completed 5 years of follow-up and 48 patients had completed 6 years of follow-up. In the entire cohort, office systolic blood pressure fell from 179±24 mm Hg to 144±28 mm Hg (P<0.0001), whereas office diastolic pressure dropped from 103±16 mm Hg to 85±18 mm Hg (P<0.0001). Heart rate fell from 74±15 beats per minute to 71±13 beats per minute (P<0.02). The effect of baroreflex activation therapy is greater than average in patients with signs of heart failure and less than average in patients with isolated systolic hypertension. In ≈25% of patients, it was possible to reduce the number of medications from a median of 6 to a median of 3. Temporary side effects, related to either the surgical procedure or the cardiovascular instability, do occur, but they do not require specific measures and resolve over time.After a follow-up of 6 years, baroreflex activation therapy maintains its efficacy for persistent reduction of office blood pressure in patients with resistant hypertension without major safety issues.
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Affiliation(s)
- Peter W de Leeuw
- From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.).
| | - John D Bisognano
- From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.)
| | - George L Bakris
- From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.)
| | - Mitra K Nadim
- From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.)
| | - Hermann Haller
- From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.)
| | - Abraham A Kroon
- From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.)
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24
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Gupta P, Patel P, Horne R, Buchanan H, Williams B, Tomaszewski M. How to Screen for Non-Adherence to Antihypertensive Therapy. Curr Hypertens Rep 2016; 18:89. [PMID: 27889904 PMCID: PMC5124437 DOI: 10.1007/s11906-016-0697-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The quality of assessment of non-adherence to treatment in hypertensive is poor. Within this review, we discuss the different methods used to assess adherence to blood-pressure-lowering medications in hypertension patients. Subjective reports such as physicians' perceptions are inaccurate, and questionnaires completed by patients tend to overreport adherence and show a low diagnostic specificity. Indirect objective methods such as pharmacy database records can be useful, but they are limited by the robustness of the recorded data. Electronic medication monitoring devices are accurate but usually track adherence to only a single medication and can be expensive. Overall, the fundamental issue with indirect objective measures is that they do not fully confirm ingestion of antihypertensive medications. Detection of antihypertensive medications in body fluids using liquid chromatography-tandem mass spectrometry is currently, in our view, the most robust and clinically useful method to assess non-adherence to blood-pressure-lowering treatment. It is particularly helpful in patients presenting with resistant, refractory or uncontrolled hypertension despite the optimal therapy. We recommend using this diagnostic strategy to detect non-adherence alongside a no-blame approach tailoring support to address the perceptions (e.g. beliefs about the illness and treatment) and practicalities (e.g. capability and resources) influencing motivation and ability to adhere.
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Affiliation(s)
- Pankaj Gupta
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
- British Heart Foundation Cardiovascular Research Centre, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Prashanth Patel
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
- British Heart Foundation Cardiovascular Research Centre, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Robert Horne
- Department of Behavioral Medicine, School of Pharmacy, University College London, London, UK
| | - Heather Buchanan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, London, UK
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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25
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Azizi M, Pereira H, Hamdidouche I, Gosse P, Monge M, Bobrie G, Delsart P, Mounier-Véhier C, Courand PY, Lantelme P, Denolle T, Dourmap-Collas C, Girerd X, Michel Halimi J, Zannad F, Ormezzano O, Vaïsse B, Herpin D, Ribstein J, Chamontin B, Mourad JJ, Ferrari E, Plouin PF, Jullien V, Sapoval M, Chatellier G, Amar L, Lorthioir A, Pagny JY, Claisse G, Midulla M, Dauphin R, Fauvel J, Rouvière O, Cremer A, Grenier N, Lebras Y, Trillaud H, Heautot J, Larralde A, Paillard F, Cluzel P, Rosenbaum D, Alison D, Claudon M, Popovic B, Rossignol P, Baguet J, Thony F, Bartoli J, Drouineau J, Sosner P, Tasu J, Velasco S, Vernhet-Kovacsik H, Bouhanick B, Rousseau H, Le Jeune S, Lopez-Sublet M, Bellmann L, Esnault V, Baguet J, Vernhet-Kovacsik H, Durand-Zaleski I, Beregi (chair) J, Lièvre M, Persu A. Adherence to Antihypertensive Treatment and the Blood Pressure–Lowering Effects of Renal Denervation in the Renal Denervation for Hypertension (DENERHTN) Trial. Circulation 2016; 134:847-57. [DOI: 10.1161/circulationaha.116.022922] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/29/2016] [Indexed: 12/20/2022]
Abstract
Background:
The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure–lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report the influence of adherence to antihypertensive treatment on blood pressure control.
Methods:
One hundred six patients with hypertension resistant to 4 weeks of treatment with indapamide 1.5 mg/d, ramipril 10 mg/d (or irbesartan 300 mg/d), and amlodipine 10 mg/d were randomly assigned to renal denervation plus standardized stepped-care antihypertensive treatment, or the same antihypertensive treatment alone. For standardized stepped-care antihypertensive treatment, spironolactone 25 mg/d, bisoprolol 10 mg/d, prazosin 5 mg/d, and rilmenidine 1 mg/d were sequentially added at monthly visits if home blood pressure was ≥135/85 mm Hg after randomization. We assessed adherence to antihypertensive treatment at 6 months by drug screening in urine/plasma samples from 85 patients.
Results:
The numbers of fully adherent (20/40 versus 21/45), partially nonadherent (13/40 versus 20/45), or completely nonadherent patients (7/40 versus 4/45) to antihypertensive treatment were not different in the renal denervation and the control groups, respectively (
P
=0.3605). The difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the 2 groups was –6.7 mm Hg (
P
=0.0461) in fully adherent and –7.8 mm Hg (
P
=0.0996) in nonadherent (partially nonadherent plus completely nonadherent) patients. The between-patient variability of daytime ambulatory systolic blood pressure was greater for nonadherent than for fully adherent patients.
Conclusions:
In the DENERHTN trial, the prevalence of nonadherence to antihypertensive drugs at 6 months was high (≈50%) but not different in the renal denervation and control groups. Regardless of adherence to treatment, renal denervation plus standardized stepped-care antihypertensive treatment resulted in a greater decrease in blood pressure than standardized stepped-care antihypertensive treatment alone.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01570777.
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Affiliation(s)
- Michel Azizi
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Helena Pereira
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Idir Hamdidouche
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Philippe Gosse
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Matthieu Monge
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Guillaume Bobrie
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Pascal Delsart
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Claire Mounier-Véhier
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Pierre-Yves Courand
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Pierre Lantelme
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Thierry Denolle
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Caroline Dourmap-Collas
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Xavier Girerd
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Jean Michel Halimi
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Faiez Zannad
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Olivier Ormezzano
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Bernard Vaïsse
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Daniel Herpin
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Jean Ribstein
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Bernard Chamontin
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Jean-Jacques Mourad
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Emile Ferrari
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Pierre-François Plouin
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Vincent Jullien
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Marc Sapoval
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - Gilles Chatellier
- From Paris-Descartes University, France (M.A., P.-F.P., V.J., M.S., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, France (M.A., G.B., P.-F.P.); INSERM, CIC1418, Paris, France (M.A., H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit, France (H.P., G.C.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Pharmacology, France (I.H., V.J.); Centre
| | - L. Amar
- Hôpital Européen Georges Pompidou, Paris (31/28)
| | - A. Lorthioir
- Hôpital Européen Georges Pompidou, Paris (31/28)
| | - J.-Y. Pagny
- Hôpital Européen Georges Pompidou, Paris (31/28)
| | | | | | - R. Dauphin
- Hôpital de la Croix Rousse and Hôpital Edouard Herriot, Lyon (14/13)
| | - J.P. Fauvel
- Hôpital de la Croix Rousse and Hôpital Edouard Herriot, Lyon (14/13)
| | - O. Rouvière
- Hôpital de la Croix Rousse and Hôpital Edouard Herriot, Lyon (14/13)
| | - A. Cremer
- Hôpital Saint André and Hôpital Pellegrin, Bordeaux (14/13)
| | - N. Grenier
- Hôpital Saint André and Hôpital Pellegrin, Bordeaux (14/13)
| | - Y. Lebras
- Hôpital Saint André and Hôpital Pellegrin, Bordeaux (14/13)
| | - H. Trillaud
- Hôpital Saint André and Hôpital Pellegrin, Bordeaux (14/13)
| | - J.F. Heautot
- Hôpital Arthur Gardiner, Dinard and CHU Rennes (12/12)
| | - A. Larralde
- Hôpital Arthur Gardiner, Dinard and CHU Rennes (12/12)
| | - F. Paillard
- Hôpital Arthur Gardiner, Dinard and CHU Rennes (12/12)
| | - P. Cluzel
- Hôpital de la Pitié Salpétrière, Paris (6/5)
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26
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Pimenta E, Calhoun DA. Drug Development for Hypertension: Do We Need Another Antihypertensive Agent for Resistant Hypertension? Curr Hypertens Rep 2016; 18:25. [PMID: 26949263 DOI: 10.1007/s11906-016-0634-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The prevalence of resistant hypertension is seemingly much lower than had been reported in early studies. Recent analyses suggest that <5 % of treated hypertensive patients remain uncontrolled if fully adherent to an optimized antihypertensive treatment. However, these patients do have increased cardiovascular risk and need effective therapeutic approaches. Drug development is a high-risk, complex, lengthy, and very expensive process. In this article, we discuss the factors that should be considered in the process of developing a new agent for treatment of resistant hypertension.
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Affiliation(s)
- Eduardo Pimenta
- Experimental Medicine CV/Hem, Clinical Sciences, Drug Discovery, Bayer Pharma AG, Aprather Weg 18a, Building 429, 42113, Wuppertal, Germany.
| | - David A Calhoun
- Sleep/Wake Disorders Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, AL, USA
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27
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Abstract
This brief review highlights new ideas about the role of the sympathetic nervous system in human blood pressure regulation. We emphasize how this role varies with age and sex and use our findings to raise questions about the sympathetic nervous system and hypertension in humans. We also focus on three additional areas, including (1) novel ideas about the carotid body and sympathoexcitation as it relates to hypertension, (2) clinical trials of renal denervation that attempted to treat hypertension by reducing ongoing sympathoexcitation, and (3) new ideas about resistant hypertension and cerebral blood flow. We further highlight that success of device-based therapy to modulate the sympathetic nervous system relies heavily on patient selection. Furthermore, data suggest that the majority of patients respond to anti-hypertensive therapy and the major cause of "resistant" hypertension is poor patient adherence. While the enthusiasm for device therapy or perhaps even "precision medicine" is high, it is likely that by far the most benefit to the most patients will occur via better screening, more aggressive therapy, and the development of strategies that improve patient adherence to medication regimens and lifestyle changes.
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Affiliation(s)
- Michael J Joyner
- Department of Anesthesiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
| | - Jacqueline K Limberg
- Department of Anesthesiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA
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