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Burnier M. Physician and patient adherence in hypertension trials: a point of view on an important issue to resolve. Expert Rev Pharmacoecon Outcomes Res 2024; 24:749-758. [PMID: 38836304 DOI: 10.1080/14737167.2024.2363401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/30/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Randomized controlled trials (RCTs) are important sources of evidence that strongly influence guidelines for patient management, including for elevated blood pressure in adults. AREAS COVERED Critical questions regarding the interpretation of hypertension trial results have recently increased, especially for concerns over methodology. In particular, investigator adherence to the protocol and patient adherence to investigational drugs are often far from optimal. These issues may be ignored or underreported because physicians' behavior during trials is often not monitored and patients' medication adherence is neither measured adequately nor reported or analyzed in the final report or in the publication. This situation may lead to misinterpretations of study results and misevaluations of the safety and efficacy profile of new drugs. In this short review, the problem of measuring, reporting, and analyzing drug adherence in RCTs is discussed and illustrated with several examples in the field of hypertension. EXPERT OPINION The main conclusion is that drug adherence should always be measured in clinical trials, possibly with more than one method. In addition, prespecified analyses of adherence data should be included in the statistical plan of all trials to improve their overall quality.
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Affiliation(s)
- Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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2
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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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3
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Borghi C, Di Micoli A, Fiorini G. Is the First Cut Always the Deepest? Hypertension 2023; 80:1180-1182. [PMID: 37196101 DOI: 10.1161/hypertensionaha.123.20701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Claudio Borghi
- Department of Medical and Surgical Sciences, IRCCS S. Orsola University of Bologna, Italy
| | - Antonio Di Micoli
- Department of Medical and Surgical Sciences, IRCCS S. Orsola University of Bologna, Italy
| | - Giulia Fiorini
- Department of Medical and Surgical Sciences, IRCCS S. Orsola University of Bologna, Italy
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Halvorsen LV, Bergland OU, Søraas CL, Larstorp ACK, Hjørnholm U, Kjær VN, Kringen MK, Clasen PE, Haldsrud R, Kjeldsen SE, Rostrup M, Fadl Elmula FEM, Opdal MS, Høieggen A. Nonadherence by Serum Drug Analyses in Resistant Hypertension: 7-Year Follow-Up of Patients Considered Adherent by Directly Observed Therapy. J Am Heart Assoc 2022; 11:e025879. [PMID: 36073648 DOI: 10.1161/jaha.121.025879] [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] [Indexed: 11/16/2022]
Abstract
Background Measurement of serum concentrations of drugs is a novelty found useful in detecting poor drug adherence in patients taking ≥2 antihypertensive agents. Regarding patients with treatment-resistant hypertension, we previously based our assessment on directly observed therapy. The present study aimed to investigate whether serum drug measurements in patients with resistant hypertension offer additional information regarding drug adherence, beyond that of initial assessment with directly observed therapy. Methods and Results Nineteen patients assumed to have true treatment-resistant hypertension and adherence to antihypertensive drugs based on directly observed therapy were investigated repeatedly through 7 years. Serum concentrations of antihypertensive drugs were measured by ultra-high-performance liquid chromatography-tandem mass spectrometry from blood samples taken at baseline, 6-month, 3-year, and 7-year visits. Cytochrome P450 polymorphisms, self-reported adherence and beliefs about medicine were performed as supplement investigations. Seven patients (37%) were redefined as nonadherent based on their serum concentrations during follow-up. All patients reported high adherence to medications. Nonadherent patients expressed lower necessity and higher concerns regarding intake of antihypertensive medication (P=0.003). Cytochrome P450 polymorphisms affecting metabolism of antihypertensive drugs were found in 16 patients (84%), 21% were poor metabolizers, and none were ultra-rapid metabolizers. Six of 7 patients redefined as nonadherent had cytochrome P450 polymorphisms, however, not explaining the low serum drug concentrations measured in these patients. Conclusions Our data suggest that repeated measurements of serum concentrations of antihypertensive drugs revealed nonadherence in one-third of patients previously evaluated as adherent and treatment resistant by directly observed therapy, thereby improving the accuracy of adherence evaluation. Registration URL: https://www.clinicaltrials.gov; unique identifier: NCT01673516.
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Affiliation(s)
- Lene V Halvorsen
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Nephrology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Ola U Bergland
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
| | - Camilla L Søraas
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Section for Environmental and Occupational Medicine Oslo University Hospital, Ullevaal Oslo Norway
| | - Anne Cecilie K Larstorp
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Medical Biochemistry Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Ulla Hjørnholm
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
| | - Vibeke N Kjær
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
| | | | - Per-Erik Clasen
- Department of Pharmacology Oslo University Hospital, Ullevaal Oslo Norway
| | - Renate Haldsrud
- Department of Pharmacology Oslo University Hospital, Ullevaal Oslo Norway
| | - Sverre E Kjeldsen
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Cardiology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Morten Rostrup
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Acute Medicine Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Basic Medical Sciences University of Oslo Norway
| | - Fadl Elmula M Fadl Elmula
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Acute Medicine Oslo University Hospital, Ullevaal Oslo Norway
| | - Mimi S Opdal
- Department of Pharmacology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Aud Høieggen
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Nephrology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
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5
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Development of UHPLC-MS/MS methods to quantify 25 antihypertensive drugs in serum in a cohort of patients treated for hypertension. J Pharm Biomed Anal 2022; 219:114908. [DOI: 10.1016/j.jpba.2022.114908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/22/2022]
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6
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Persu A, Maes F, Toennes SW, Ritscher S, Georges C, Wallemacq P, Haratani N, Parise H, Fischell TA, Lauder L, Mahfoud F. Impact of drug adherence on blood pressure response to alcohol-mediated renal denervation. Blood Press 2022; 31:109-117. [PMID: 35575248 DOI: 10.1080/08037051.2022.2074367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE While poor drug adherence is frequent in patients with resistant hypertension, detailed analyses of the impact of drug adherence on the success of renal denervation are scarce. We report drug adherence at baseline, changes in drug adherence, and the influence of these parameters on blood pressure changes at 6 and 12 months in patients treated with alcohol-mediated renal denervation as part of the Peregrine study. MATERIALS AND METHODS Urinary detection of antihypertensive drugs was performed using high-performance liquid chromatography-tandem mass spectrometry. Full adherence, partial adherence, and complete non-adherence were defined as 0, 1, or ≥2 drugs not detected, respectively. RESULTS Renal denervation was performed in 45 patients with uncontrolled hypertension on ≥3 antihypertensive medications (62% men, age 55 ± 10 years). At baseline, the proportion of fully, partially, and non-adherent patients was 62% (n = 28), 16% (n = 7), and 22% (n = 10), respectively. At 6 months, adherence improved by 21% (n = 9), remained unchanged at 49% (n = 21), and worsened by 30% (n = 13). Mean 24-h systolic blood pressure decreased by 10 ± 13, 10 ± 4, and 14 ± 19 mmHg in fully, partially, and non-adherent patients (p = 0.77), and by 14 ± 14, 8 ± 11, and 14 ± 18 mmHg in patients who improved, maintained, or decreased adherence, respectively (p = 0.35). The results at 12 months were similar. CONCLUSION About 40% of patients with apparently treatment-resistant hypertension were not fully adherent at baseline, and adherence decreased further in 30%. Nevertheless, mean blood pressure changes after renal denervation were similar irrespective of drug adherence. Our results suggest that such patients may benefit from alcohol-mediated renal denervation, irrespective of drug adherence. These findings are hypothesis-generating and need to be confirmed in ongoing sham-controlled trials.
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Affiliation(s)
- Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Frédéric Maes
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Stefan W Toennes
- Institute of Legal Medicine, Goethe University, Frankfurt, Germany
| | - Sabrina Ritscher
- Institute of Legal Medicine, Goethe University, Frankfurt, Germany
| | - Coralie Georges
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre Wallemacq
- Clinical Chemistry Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | | | | | - Lucas Lauder
- Department of Internal Medicine III, Saarland University Medical Center, Homburg, Germany
| | - Felix Mahfoud
- Department of Internal Medicine III, Saarland University Medical Center, Homburg, Germany
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Prevalence, phenotypic characteristics and prognostic role of apparent treatment resistant hypertension in the German Chronic Kidney Disease (GCKD) study. J Hum Hypertens 2022; 37:345-353. [PMID: 35534618 DOI: 10.1038/s41371-022-00701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/30/2022] [Accepted: 04/21/2022] [Indexed: 11/12/2022]
Abstract
Treatment resistant hypertension (TRH) appears of particular relevance in patients with chronic kidney disease (CKD). However, causes and consequences of TRH in CKD patients remain incompletely understood. Therefore, we analyzed the prevalence of apparent TRH (aTRH), and phenotypic characteristics and prognosis associated with aTRH among participants of the German Chronic Kidney Disease (GCKD) study. As insufficient medication adherence has been shown to be a frequent cause of pseudoresistance, we also assessed treatment adherence. Study participants were classified as having aTRH, controlled hypertension and uncontrolled hypertension based on study visit blood pressure and self-reported medication intake. Drug adherence was assessed by comparing self-reported antihypertensive medication with detectable urinary drug metabolites measured by mass spectroscopy. Out of 4901 individuals included in this study, 38% were classified as having aTRH. Male sex, older age, lower estimated glomerular filtration rate (eGFR), higher body mass index (BMI), higher urine albumin-to-creatinine ratio (UACR) and presence of diabetes mellitus were independently associated with higher prevalence of aTRH in a multivariable adjusted regression model. Patients classified as aTRH had higher risk for major adverse cardiovascular events and worsening of kidney disease compared to patients with no aTRH after multivariate adjustment for potential confounders. There was a high agreement between self-reported medication and detectable urinary drug metabolites. In conclusion, in a cohort of Caucasian patients with moderately severe CKD, aTRH was highly prevalent and, in most cases, likely not caused by low medication adherence. Furthermore, aTRH was linked to cardio-renal endpoints, emphasizing the need for improved management.
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Vedar C, Bamat NA, Zuppa AF, Reilly ME, Moorthy GS. Development, validation, and implementation of an UHPLC-MS/MS method for the quantitation of furosemide in infant urine samples. Biomed Chromatogr 2022; 36:e5262. [PMID: 34648199 PMCID: PMC8881385 DOI: 10.1002/bmc.5262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 11/06/2022]
Abstract
Furosemide is a diuretic drug used to increase urine flow in order to reduce the amount of salt and water in the body. It is commonly utilized to treat preterm infants with chronic lung disease of prematurity. There is a need for a simple and reliable quantitation of furosemide in human urine. We have developed and validated an ultra-high performance liquid chromatography-tandem mass spectrometry method for furosemide quantitation in human urine with an assay range of 0.100-50.0 μg/ml. Sample preparation involved solid-phase extraction with 10 μl of urine. Intra-day accuracies and precisions for the quality control samples were 94.5-106 and 1.86-10.2%, respectively, while inter-day accuracies and precision were 99.2-102 and 3.38-7.41%, respectively. Recovery for furosemide had an average of 23.8%, with an average matrix effect of 101%. Furosemide was stable in human urine under the assay conditions. Stability for furosemide was shown at 1 week (room temperature, 4, -20 and -78°C), 6 months (-78°C), and through three freeze-thaw cycles. This robust assay demonstrates accurate and precise quantitation of furosemide in a small volume (10 μl) of human urine. It is currently being implemented in an ongoing pediatric clinical study.
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Affiliation(s)
- Christina Vedar
- Center for Clinical Pharmacology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104
| | - Nicolas A. Bamat
- Center for Clinical Pharmacology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104,Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19104
| | - Athena F. Zuppa
- Center for Clinical Pharmacology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104,Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104
| | - Megan E. Reilly
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19104
| | - Ganesh S. Moorthy
- Center for Clinical Pharmacology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104,Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104,Address correspondence to: Ganesh S. Moorthy, PhD, Center for Clinical Pharmacology, The Children’s Hospital of Philadelphia, 3615 Civic Center Blvd, ARC 516A, Philadelphia, PA 19104, Tel: 215 590 0142,
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Hoogerwaard AF, Adiyaman A, de Jong MR, Smit JJJ, Heeg JE, van Hasselt BAAM, Elvan A. Renal nerve stimulation: complete versus incomplete renal sympathetic denervation. Blood Press 2021; 30:376-385. [PMID: 34647513 DOI: 10.1080/08037051.2021.1982376] [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: 12/27/2022]
Abstract
PURPOSE Blood pressure (BP) reduction after renal sympathetic denervation (RDN) is highly variable. Renal nerve stimulation (RNS) can localize sympathetic nerves. The RNS trial aimed to investigate the medium-term BP-lowering effects of the use of RNS during RDN, and explore if RNS can check the completeness of the denervation. MATERIAL AND METHODS Forty-four treatment-resistant hypertensive patients were included in the prospective, single-center RNS trial. The primary study endpoint was change in 24-h BP at 6- to 12-month follow-up after RDN. The secondary study endpoints were the acute procedural RNS-induced BP response before and after RDN; number of antihypertensive drugs at follow-up; and the correlation between the RNS-induced BP increase before versus after RDN (delta [Δ] RNS-induced BP). RESULTS Before RDN, the RNS-induced systolic BP rise was 43(±21) mmHg, and decreased to 9(±12) mmHg after RDN (p < 0.001). Mean 24-h systolic/diastolic BP decreased from 147(±12)/82(±11) mmHg at baseline to 135(±11)/76(±10) mmHg (p < 0.001/<0.001) at follow-up (10 [6-12] months), with 1 antihypertensive drug less compared to baseline. The Δ RNS-induced BP and the 24-h BP decrease at follow-up were correlated for systolic (R = 0.44, p = 0.004) and diastolic (R = 0.48, p = 0.003) BP. Patients with ≤0 mmHg residual RNS-induced BP response after RDN had a significant lower mean 24-h systolic BP at follow-up compared to the patients with >0 mmHg residual RNS-induced BP response (126 ± 4 mmHg versus 135 ± 10 mmHg, p = 0.04). 83% of the patients with ≤0 mmHg residual RNS-induced BP response had normal 24-h BP at follow-up, compared to 33% in the patients with >0 mmHg residual RNS-induced BP response (p = 0.023). CONCLUSION The use of RNS during RDN leads to clinically significant and sustained lowering of 24-h BP with fewer antihypertensive drugs at follow-up. RNS-induced BP changes were correlated with 24-h BP changes at follow-up. Moreover, patients with complete denervation had significant lower BP compared to the patients with incomplete denervation.
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Affiliation(s)
| | - Ahmet Adiyaman
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Mark R de Jong
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jaap-Jan J Smit
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jan-Evert Heeg
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | | | - Arif Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
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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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Lauder L, Ewen S, Glasmacher J, Lammert F, Reith W, Schreiber N, Kaddu-Mulindwa D, Ukena C, Böhm M, Meyer MR, Mahfoud F. Drug adherence and psychosocial characteristics of patients presenting with hypertensive urgency at the emergency department. J Hypertens 2021; 39:1697-1704. [PMID: 33734143 DOI: 10.1097/hjh.0000000000002842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify potentially targetable psychosocial factors associated with nonadherence to prescribed antihypertensive medications in patients presenting with hypertensive urgencies at an emergency department. METHODS This prospective study included patients treated with antihypertensive drugs who presented with hypertensive urgencies (SBP ≥180 mmHg and/or DBP ≥110 mmHg) at the emergency department of a tertiary referral clinic between April 2018 and April 2019. Health literacy was assessed using the Newest Vital Sign test. The Hospital Anxiety and Depression Scale (HADS) was used to quantify symptoms of anxiety and depression. Patients were classified nonadherent if less than 80% of the prescribed antihypertensive drugs were detectable in urine or plasma using liquid chromatography-high-resolution mass spectrometry. RESULTS A total of 104 patients (62% women) presenting with hypertensive urgencies with a median SBP of 200 mmHg (IQR 190-212) and DBP of 97.5 mmHg (IQR 87-104) were included. Twenty-five patients (24%) were nonadherent to their antihypertensive medication. Nonadherent patients were more often men (66 versus 23%, P = 0.039), prescribed higher numbers of antihypertensive drugs (median 3, IQR 3-4 versus 2, IQR 1-3; P < 0.001), and more often treated with calcium channel blockers (76 versus 25%; P < 0.001) and/or diuretics (64 versus 40%; P = 0.030). There was no difference in health literacy (P = 0.904) or the scores on the HADS subscales for depression (P = 0.319) and anxiety (P = 0.529) between adherent and nonadherent patients. CONCLUSION Male sex, higher numbers of antihypertensive drugs, and treatment with diuretics and/or calcium channel blockers were associated with nonadherence. We did not identify a specific psychosocial characteristic associated with nonadherence.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University.,Emergency Department, Universitätsklinikum des Saarlandes
| | - Julius Glasmacher
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University
| | | | | | - Naemi Schreiber
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University
| | - Dominic Kaddu-Mulindwa
- Department of Hematology, Oncology, Clinical Immunology, Rheumatology, Saarland University Medical Center
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University
| | - Markus R Meyer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University, Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University.,Institute for Medical Engineering and Science, MIT, Cambridge, Massachusetts, USA
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Mostafavi F, Alavijeh FZ, Salahshouri A, Mahaki B. The psychosocial barriers to medication adherence of patients with type 2 diabetes: a qualitative study. Biopsychosoc Med 2021; 15:1. [PMID: 33461565 PMCID: PMC7812642 DOI: 10.1186/s13030-020-00202-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/11/2020] [Indexed: 11/25/2022] Open
Abstract
Background The adherence of diabetic patients to their medication regimen is associated with many psychosocial factors that are still unknown. Therefore, the present study aims to identify the psychosocial barriers to medication adherence of patients with type2 diabetes (T2D). Methodology This descriptive qualitative study was done in Isfahan, Iran by conducting in-depth unstructured interviews with 23 purposively selected patients with T2D and 10 healthcare providers (HCPs). The participants were interviewed face-to-face between November 2017 and June 2018 at the patient’s home, a Health Care Center, or at the diabetes clinic. Data analysis was performed using MAXQDA-10 software and the conventional content analysis. Results The analysis of the data led to six categories of perceived psychosocial barriers: 1) fear, concern and distress, 2) exhaustion and burnout, 3) the children’s issues being the priority, 4) poor financial support, 5) communication challenges, and 6) poor work conditions. Conclusions This study identified some of the psychosocial barriers to medication adherence of patients with T2D, which will be of great help to researchers and HCPs in designing and implementing effective interventions to overcome these barriers and change patient self-care behaviors and increase their medication adherence.
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Affiliation(s)
- Firoozeh Mostafavi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Zamani Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Salahshouri
- Department of Health Education and Promotion, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, 61357 - 15751, Iran.
| | - Behzad Mahaki
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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14
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McDonough CW, Babcock K, Chucri K, Crawford DC, Bian J, Modave F, Cooper-DeHoff RM, Hogan WR. Optimizing identification of resistant hypertension: Computable phenotype development and validation. Pharmacoepidemiol Drug Saf 2020; 29:1393-1401. [PMID: 32844549 DOI: 10.1002/pds.5095] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Computable phenotypes are constructed to utilize data within the electronic health record (EHR) to identify patients with specific characteristics; a necessary step for researching a complex disease state. We developed computable phenotypes for resistant hypertension (RHTN) and stable controlled hypertension (HTN) based on the National Patient-Centered Clinical Research Network (PCORnet) common data model (CDM). The computable phenotypes were validated through manual chart review. METHODS We adapted and refined existing computable phenotype algorithms for RHTN and stable controlled HTN to the PCORnet CDM in an adult HTN population from the OneFlorida Clinical Research Consortium (2015-2017). Two independent reviewers validated the computable phenotypes through manual chart review of 425 patient records. We assessed precision of our computable phenotypes through positive predictive value (PPV) and test validity through interrater reliability (IRR). RESULTS Among the 156 730 HTN patients in our final dataset, the final computable phenotype algorithms identified 24 926 patients with RHTN and 19 100 with stable controlled HTN. The PPV for RHTN in patients randomly selected for validation of the final algorithm was 99.1% (n = 113, CI: 95.2%-99.9%). The PPV for stable controlled HTN in patients randomly selected for validation of the final algorithm was 96.5% (n = 113, CI: 91.2%-99.0%). IRR analysis revealed a raw percent agreement of 91% (152/167) with Cohen's kappa statistic = 0.87. CONCLUSIONS We constructed and validated a RHTN computable phenotype algorithm and a stable controlled HTN computable phenotype algorithm. Both algorithms are based on the PCORnet CDM, allowing for future application to epidemiological and drug utilization based research.
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Affiliation(s)
- Caitrin W McDonough
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Kyle Babcock
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Kristen Chucri
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Dana C Crawford
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jiang Bian
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - François Modave
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA.,Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - William R Hogan
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
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15
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Benefit of serum drug monitoring complementing urine analysis to assess adherence to antihypertensive drugs in first-line therapy. PLoS One 2020; 15:e0237383. [PMID: 32776967 PMCID: PMC7416922 DOI: 10.1371/journal.pone.0237383] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/24/2020] [Indexed: 12/05/2022] Open
Abstract
With obesity having doubled in the last decade, hypertension is on the rise. In one-third of hypertensive patients the metabolic syndrome is present. This might be one factor for the increasing number of prescriptions for angiotensin receptor blockers and calcium-channel blockers besides a more favorable risk-to-benefit ratio. The aim of the present study was to evaluate a therapeutic drug monitoring (TDM) method for assessment of adherence based on cut-offs in inpatients and to compare it to an established urine drug screening in outpatients. A method for quantification of calcium-channel blockers and angiotensin receptor blockers using high-performance liquid chromatography-tandem mass spectrometric analysis (LC-MS/MS) was developed and validated. The method was applied to serum samples of 32 patients under supervised medication to establish cut-off values for adherence assessment based on dose-related concentrations (DRC, calculated from pharmacokinetic data). Furthermore, corresponding urine and blood samples of 42 outpatients without supervised medication were analysed and the results compared with regard to adherence assessment. All serum concentrations measured for amlodipine (n = 40), lercanidipine (n = 14), candesartan (n = 10), telmisartan (n = 4) and valsartan (n = 10) in inpatients were above the patient specific lower DRC confirming adherence. Of 42 outpatients the identification of analytes in urine as well as the quantification in serum exhibited differing results. According to urinalysis, adherence was demonstrated in only 87.0% of prescriptions, compared to 91.3% for serum analyses. Differences were observed for amlodipine, lercanidipine and candesartan which can be explained by a higher specificity of the serum analysis approach due to pharmacokinetics. The present study confirms that assessing adherence based on serum drug concentrations with individually calculated lower DRCs is more accurate than using qualitative urine analysis. In particular, drugs with low bioavailability, low renal excretion or high metabolism rate such as lercanidipine and candesartan may lead to underestimation of adherence via urine analysis.
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16
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Williams B, Masi S, Wolf J, Schmieder RE. Facing the Challenge of Lowering Blood Pressure and Cholesterol in the Same Patient: Report of a Symposium at the European Society of Hypertension. Cardiol Ther 2020; 9:19-34. [PMID: 31933276 PMCID: PMC7237547 DOI: 10.1007/s40119-019-00159-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Indexed: 11/24/2022] Open
Abstract
A symposium held at the 29th European Meeting on Hypertension and Cardiovascular Protection in Milan, Italy, discussed the potential impact and long-term benefits of early active management of cardiovascular disease (CVD) risk in patients with hypertension, and potential barriers to this strategy. Hypertension often aggregates with other cardiovascular risk factors, exponentially increasing morbidity and mortality. While effective therapies to treat hypertension exist, a substantial number of patients still experience major cardiovascular events. Two major issues account for these disappointing results: interventions initiated too late in the disease trajectory and lack of effective translation of the research findings into daily clinical practice. Results from genetic studies suggest that lifetime exposure to lower blood pressure (BP) and cholesterol levels due to protective gene mutations, can provide greater cardiovascular benefits than middle-/late-age interventions. Clinical guidelines suggest adding statins to BP-lowering therapies for further cardiovascular benefits in most hypertensive patients; however, real-world data show that physicians' compliance with these recommendations and patients' adherence to BP- and lipid-lowering treatments remain poor, resulting in poor risk factor control and an increased risk of adverse outcomes. The use of single-pill combinations (SPC) can partially mitigate these issues, as they are associated with increased patient adherence and improved BP control. Treatment with SPC has been recommended in the European Hypertension Guidelines, but optimization of the total CVD risk may need adoption of more ambitious treatment strategies aimed to deliver single pills that control multiple CVD risk factors. Amlodipine, perindopril and atorvastatin have been shown to improve BP and lipid levels to a great extent when given separately, and this combination has also been shown to improve cardiovascular outcomes. Overall, early intervention in patients with hypertension with use of an effective, high-intensity cardiovascular risk reduction regimen and attention to medication adherence through reducing pill burden are likely to result in optimal outcomes.
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Affiliation(s)
- Bryan Williams
- Institute of Cardiovascular Sciences, University College London, London, UK.
| | - Stefano Masi
- Institute of Cardiovascular Sciences, University College London, London, UK
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Jacek Wolf
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University Erlangen Nuremberg, Erlangen, Germany
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17
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Ritscher S, Georges C, Wunder C, Wallemacq P, Persu A, Toennes SW. Assessment of adherence to diuretics and β-blockers by serum drug monitoring in comparison to urine analysis. Blood Press 2020; 29:291-298. [PMID: 32400211 DOI: 10.1080/08037051.2020.1763775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Toxicological screenings for identifying antihypertensive drugs proved to be a useful tool for assessing adherence. However, misinterpretation may occur in case of highly metabolised drugs with low renal excretion, as well as for drugs with a prolonged detectability. The aim of the present study was to compare a recently developed therapeutic drug monitoring (TDM) method based on serum concentrations to an urine drug detection method for assessing adherence in outpatients.Materials and methods: Corresponding urine and blood samples were obtained at the same time from 26 outpatients without supervised medication. Urine and serum analyses were performed using established high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) methodologies. Adherence was assumed if drugs were detectable in urine or if serum concentrations were above individually calculated lower dose-related concentrations (DRC) or literature-based therapeutic reference ranges (TRR) used as cut-off, respectively.Results: The identification of analytes in urine as well as the quantitative serum assay were performed for atenolol (n = 6 patients), bisoprolol (n = 8), nebivolol (n = 6), canrenone (n = 6, metabolite of spironolactone), hydrochlorothiazide (n = 12) and furosemide (n = 2). On the basis of drug detectability in urine, adherence was assumed in 88% of prescriptions. In 81% (DRC) and 50% (TRR) of the serum analyses the cut-off value was exceeded, which confirms patients' adherence in a lower number. Differences in adherence rates were found in five patients, mainly for β-blockers.Conclusion: This study suggests that assessment of adherence can be performed more precisely on the basis of serum drug concentrations with individually calculated lower DRC than by using the TRR or qualitative urinalysis.
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Affiliation(s)
- Sabrina Ritscher
- Institute of Legal Medicine, Department of Forensic Toxicology, University Hospital, Goethe University, Frankfurt, Germany
| | - Coralie Georges
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Cora Wunder
- Institute of Legal Medicine, Department of Forensic Toxicology, University Hospital, Goethe University, Frankfurt, Germany
| | - Pierre Wallemacq
- Clinical Chemistry Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Center for Toxicology and Applied Pharmacology, Université Catholique de Louvain, Brussels, Belgium
| | - 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, Brussels, Belgium
| | - Stefan W Toennes
- Institute of Legal Medicine, Department of Forensic Toxicology, University Hospital, Goethe University, Frankfurt, Germany
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18
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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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19
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Abstract
The global epidemic of hypertension is largely uncontrolled and hypertension remains the leading cause of noncommunicable disease deaths worldwide. Suboptimal adherence, which includes failure to initiate pharmacotherapy, to take medications as often as prescribed, and to persist on therapy long-term, is a well-recognized factor contributing to the poor control of blood pressure in hypertension. Several categories of factors including demographic, socioeconomic, concomitant medical-behavioral conditions, therapy-related, healthcare team and system-related factors, and patient factors are associated with nonadherence. Understanding the categories of factors contributing to nonadherence is useful in managing nonadherence. In patients at high risk for major adverse cardiovascular outcomes, electronic and biochemical monitoring are useful for detecting nonadherence and for improving adherence. Increasing the availability and affordability of these more precise measures of adherence represent a future opportunity to realize more of the proven benefits of evidence-based medications. In the absence of new antihypertensive drugs, it is important that healthcare providers focus their attention on how to do better with the drugs they have. This is the reason why recent guidelines have emphasize the important need to address drug adherence as a major issue in hypertension management.
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Affiliation(s)
- Michel Burnier
- From the Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (M.B.)
| | - Brent M Egan
- Department of Medicine, Care Coordination Institute, University of South Carolina School of Medicine, Greenville, SC (B.M.E.)
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20
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Shakya R, Shrestha S, Gautam R, Rai L, Maharjan S, Satyal GK, KC B, Rai MK. Perceived Illness and Treatment Adherence to Hypertension Among Patients Attending a Tertiary Hospital in Kathmandu, Nepal. Patient Prefer Adherence 2020; 14:2287-2300. [PMID: 33244224 PMCID: PMC7685346 DOI: 10.2147/ppa.s270786] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/16/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Hypertension (HTN) is a silent killer, accountable for life-threatening complications. An individual's illness perception may affect adherence to treatment which is crucial to prevent complications of HTN. The objective of this study was to identify illness perception and treatment adherence among patients with HTN in a tertiary hospital in Kathmandu, Nepal. METHODS Descriptive correlational study was conducted in the out-patient department of Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu Nepal. Non-probability purposive sampling was used. A face-to-face interview was conducted from September to December 2018, using a structured questionnaire that included socio-demographic variables, illness perception questionnaire (revised) and Hill bone compliance to high blood pressure therapy scale. Data analysis was done by using descriptive and inferential statistics (chi-square test, Spearman rank correlation). RESULTS Among 204 participants, 51% were male, 77% were literate, mean ± S.D. age was 60±12. About 72% experienced headache and 88% said that headache is related to HTN. Behavioural factors and psychological factors were regarded as the leading cause of HTN. Almost 63% participants believed HTN as highly threatening illness. Higher scores in timeline (acute/chronic), personal control, and treatment control revealed that patients believed HTN as a chronic disease with a higher rate of personal and treatment control. Regarding treatment adherence, the mean score was 16.58 (SD = 2.08), and only 14.7% had perfect adherence. Participants were more adherent to medication and appointment keeping rather than reduce salt intake. Duration of HTN diagnosis (p=0.027) and duration under HTN medication (p= 0.021) were found to be significantly associated with treatment adherence. There was a significant positive correlation between illness perception and treatment adherence (ρ = 0.282, p<0.01). CONCLUSION Illness perception and treatment adherence are correlated. Hence, it is beneficial to improve illness perception to achieve perfect treatment adherence. Reinforcement is essential to maintain adherence to both medications and behaviour therapy.
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Affiliation(s)
- Rajina Shakya
- Department of Nursing, Nobel College, Pokhara University, Sinamangal, Kathmandu, Nepal
- Correspondence: Rajina Shakya Email
| | - Sunil Shrestha
- Department of Pharmacy, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Roshani Gautam
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Lalita Rai
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | | | - Gita Kumari Satyal
- Female Surgical Ward, Department of Nursing, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bhuvan KC
- School of Pharmacy, Monash University Malaysia, Subang Jaya47500, Selangor, Malaysia
- Bhuvan KC Email
| | - Mana Kumari Rai
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
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21
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Yakar B, Azakoglu Karaca A, Onalan E. Hipertansif hastalarda ilaç tedavisine uyum ve etkileyen faktörlerin değerlendirilmesi. FAMILY PRACTICE AND PALLIATIVE CARE 2019. [DOI: 10.22391/fppc.609576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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22
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Evaluation of the dose-related concentration approach in therapeutic drug monitoring of diuretics and β-blockers - drug classes with low adherence in antihypertensive therapy. Sci Rep 2019; 9:15652. [PMID: 31666620 PMCID: PMC6821771 DOI: 10.1038/s41598-019-52164-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/12/2019] [Indexed: 11/17/2022] Open
Abstract
Detection of antihypertensive drugs in biological samples is an important tool to assess the adherence of hypertensive patients. Urine and serum/plasma screenings based on qualitative results may lead to misinterpretations regarding drugs with a prolonged detectability. The aim of the present study was to develop a method that can be used for therapeutic drug monitoring (TDM) of antihypertensive drugs with focus on adherence assessment. Therefore, a method for quantification of four diuretics and four β-blockers using high-performance liquid chromatography-mass spectrometric analysis (LC-MS/MS) of combined acidic and basic serum extracts was developed and validated. The method was applied to 40 serum samples from 20 patients in a supervised medication setting (trough and peak serum samples). Literature data on therapeutic concentration ranges, as well as dose-related drug concentrations (calculated from data of pharmacokinetic studies) were used to evaluate adherence assessment criteria. Concentrations were measured for bisoprolol (n = 9 patients), metoprolol (n = 7), nebivolol (n = 1), canrenone (n = 2, metabolite of spironolactone), hydrochlorothiazide (n = 10) and torasemide (n = 8). The measured concentrations were within the therapeutic reference ranges, except for 24% of the samples (mainly β-blockers). In contrast, all measured concentrations were above the lower dose-related concentration (DRC), which appears superior in evaluating adherence. In conclusion, the quantitative analysis of antihypertensive drugs in serum samples and its evaluation on the basis of the individually calculated lower DRC is a promising tool to differentially assess adherence. This method could possibly detect a lack of adherence or other causes of insufficient therapy more reliably than qualitative methods.
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23
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Shankar SP, Suman Babu ISS, Ramya N. A study on usefulness of modified medication adherence scale in assessing adherence among hypertensive patients. Perspect Clin Res 2019; 10:163-167. [PMID: 31649865 PMCID: PMC6801989 DOI: 10.4103/picr.picr_44_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Adherence to medication is important for control of blood pressure (BP) and prevention of its complications. Identifying factors which improve adherence to treatment helps in improving cardiovascular outcome. Aim: The aim is to study the adherence of hypertensive patients to medication using modified medication adherence scale (MMAS). Materials and Methods: This study was done as a cross-sectional study in the Department of General medicine in Aarupadai Veedu Medical College and Hospital, Puducherry, from May 2017 to October 2017. All adult patients of both sexes diagnosed to have hypertension were included in the study after obtaining informed consent. Adherence to hypertension was assessed using MMAS and results were analyzed. SPSS 22 software (International Business Machines Corporation, Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY) was used for statistical purposes. Results: A total of 150 patients were included in the study. There were 83 males and 67 females in the study. Good adherence was observed in 74 (49%) out of the total 150. Forty-nine (59%) males and 25 (37%) females were found adherent to treatment. Patients with monotherapy had a good adherence compared to those with polytherapy. Patients with good adherence had a good control of BP. Conclusion: MMAS is a simple and useful tool for assessing medication adherence among hypertensive patients.
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Affiliation(s)
- Sethu Prabhu Shankar
- Department of General Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India
| | - I S S Suman Babu
- Department of General Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India
| | - Neelakandan Ramya
- Department of General Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India
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24
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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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25
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Singh K, Choudhry NK, Krumme AA, McKay C, McElwee NE, Kimura J, Franklin JM. A concept-wide association study to identify potential risk factors for nonadherence among prevalent users of antihypertensives. Pharmacoepidemiol Drug Saf 2019; 28:1299-1308. [PMID: 31313427 PMCID: PMC11293841 DOI: 10.1002/pds.4850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 11/07/2022]
Abstract
PURPOSE We sought to determine whether an association study using information contained in clinical notes could identify known and potentially novel risk factors for nonadherence to antihypertensive medications. METHODS We conducted a retrospective concept-wide association study (CWAS) using clinical notes to identify potential risk factors for medication nonadherence, adjusting for age, sex, race, baseline blood pressure, estimated glomerular filtration rate, and a combined comorbidity score. Participants included Medicare beneficiaries 65 years and older receiving care at the Harvard Vanguard Medical Associates network from 2010-2012 and enrolled in a Medicare Advantage program. Concepts were extracted from clinical notes in the year prior to the index prescription date for each patient. We tested associations with the outcome for 5013 concepts extracted from clinical notes in a derivation cohort (4382 patients) and accounted for multiple hypothesis testing by using a false discovery rate threshold of less than 5% (q < .05). We then confirmed the associations in a validation cohort (3836 patients). Medication nonadherence was defined using a proportion of days covered (PDC) threshold less than 0.8 using pharmacy claims data. RESULTS We found 415 concepts associated with nonadherence, which we organized into 11 clusters using a hierarchical clustering approach. Volume depletion and overload, assessment of needs at the point of discharge, mood disorders, neurological disorders, complex coordination of care, and documentation of noncompliance were some of the factors associated with nonadherence. CONCLUSIONS This approach was successful in identifying previously described and potentially new risk factors for antihypertensive nonadherence using the clinical narrative.
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Affiliation(s)
- Karandeep Singh
- Departments of Learning Health Sciences and Internal Medicine, University of Michigan Medical School and University of Michigan School of Information, Ann Arbor, MI
| | - Niteesh K. Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Alexis A. Krumme
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | | | | | - Joe Kimura
- Atrius Health and Harvard Medical School, Boston, MA
| | - Jessica M. Franklin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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26
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Siddiqui M, Judd EK, Dudenbostel T, Zhang B, Gupta P, Tomaszewski M, Patel P, Oparil S, Calhoun DA. Masked Uncontrolled Hypertension Is Not Attributable to Medication Nonadherence. Hypertension 2019; 74:652-659. [PMID: 31327263 DOI: 10.1161/hypertensionaha.119.13258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Masked uncontrolled hypertension (MUCH) in treated hypertensive patients is defined as controlled automated office blood pressure (BP; <135/85 mm Hg) in-clinic but uncontrolled out-of-clinic BP by ambulatory BP monitoring (awake [daytime] readings ≥135/85 mm Hg or 24-hour readings ≥130/80 mm Hg). To determine whether MUCH is attributable to antihypertensive medication nonadherence. One hundred eighty-four enrolled patients were confirmed to have controlled office BP; of these, 167 patients were with adequate 24-hour ambulatory BP recordings. Of 167 patients, 86 were controlled by in-clinic BP assessment but had uncontrolled ambulatory awake BP, indicative of MUCH. The remaining 81 had controlled in-clinic and ambulatory awake BP, consistent with true controlled hypertension. After exclusion of 9 patients with missing 24-hour urine collections, antihypertensive medication adherence was determined based on the detection of urinary drugs or drug metabolites by high-performance liquid chromatography-tandem mass spectrometry. Of the 81 patients with MUCH, 69 (85.2%) were fully adherent and 12 (14.8%) were partially adherent (fewer medications detected than prescribed). Of the 77 patients with true controlled hypertension, 69 (89.6%) were fully adherent with prescribed antihypertensive medications and 8 (10.4%) were partially adherent. None of the patients in either group were fully nonadherent. There was no statistically significant difference in complete or partial adherence between the MUCH and true controlled groups (P=0.403). Measurement of urinary drug and drug metabolite levels demonstrates a similarly high level of antihypertensive medication adherence in both MUCH and truly controlled hypertensive patients. These findings indicate that MUCH is not attributable to antihypertensive medication nonadherence.
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Affiliation(s)
- Mohammed Siddiqui
- From the Vascular Biology and Hypertension Program (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
| | - Eric K Judd
- Division of Nephrology (E.K.J.), University of Alabama at Birmingham
| | - Tanja Dudenbostel
- From the Vascular Biology and Hypertension Program (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (B.Z.).,Department of Pediatrics, University of Cincinnati College of Medicine, University of Cincinnati, OH (B.Z.)
| | - Pankaj Gupta
- Department of Chemical Pathology and Metabolic Medicine, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P.).,Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P.)
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (M.T.)
| | - Prashanth Patel
- Department of Chemical Pathology and Metabolic Medicine, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P.).,Department of Cardiovascular Sciences, University of Leicester, United Kingdom (P.G., P.P.)
| | - Suzanne Oparil
- From the Vascular Biology and Hypertension Program (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
| | - David A Calhoun
- From the Vascular Biology and Hypertension Program (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
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Phase II randomized sham-controlled study of renal denervation for individuals with uncontrolled hypertension - WAVE IV. J Hypertens 2019; 36:680-689. [PMID: 29035942 DOI: 10.1097/hjh.0000000000001584] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this double-blind, randomized, sham-controlled study was to verify the blood pressure (BP)-lowering efficacy of externally delivered focused ultrasound for renal denervation (RDN). BACKGROUND Nonrandomized, first proof-of-concept study and experimental evidence suggested that noninvasive techniques of RDN emerged as an alternative approach of RDN to invasive technologies. METHODS WAVE IV, an international, randomized (1 : 1) sham-controlled, double-blind prospective clinical study, was prematurely stopped. Patients were enrolled if office BP was at least 160 mmHg and 24-h ambulatory BP was at least 135 mmHg, while taking three or more antihypertensive medications. The treatment consisted of bilateral RDN using therapeutic levels of ultrasound energy and the sham consisted of bilateral application of diagnostic levels of ultrasound energy. RESULTS In the 81 treated patients neither changes in office BP at 12 and 24 weeks, nor changes in 24-h ambulatory BP at 24-week follow-up visit differed between the two groups significantly. Of note, no safety signal was observed. Adherence analysis disclosed full adherence in 77% at baseline and 82% at 6 months' follow-up visit. Post hoc analysis revealed that stricter criteria for stabilization of BP at baseline were associated with a numerically greater change in 24-h ambulatory BP in the RDN group than in the sham group. CONCLUSION Our data did not prove that antihypertensive efficacy of the externally delivered focused ultrasound for RDN was greater than the sham effect. Stabilization of BP at baseline was identified as an important determinant of BP changes.
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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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van Schoonhoven AV, van Asselt AD, Tomaszewski M, Patel P, Khunti K, Gupta P, Postma MJ. Cost-Utility of an Objective Biochemical Measure to Improve Adherence to Antihypertensive Treatment. Hypertension 2018; 72:1117-1124. [DOI: 10.1161/hypertensionaha.118.11227] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Alexander V. van Schoonhoven
- From the Unit of PharmacoTherapy, -Epidemiology, and -Economics, Department of Pharmacy, University of Groningen, The Netherlands (A.V.v.S., A.D.I.v.A., M.J.P.)
| | - Antoinette D.I. van Asselt
- From the Unit of PharmacoTherapy, -Epidemiology, and -Economics, Department of Pharmacy, University of Groningen, The Netherlands (A.V.v.S., A.D.I.v.A., M.J.P.)
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, The Netherlands (A.D.I.v.A., M.J.P.)
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (M.T., P.G.)
- Division of Medicine, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.)
| | - Prashanth Patel
- Department of Chemical Pathology and Metabolic Diseases, University Hospitals of Leicester NHS Trust, United Kingdom (P.P., P.G.)
- Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre, University of Leicester, United Kingdom (P.P., P.G.)
| | - Kamlesh Khunti
- Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre, University of Leicester, United Kingdom (P.P., P.G.)
| | - Pankaj Gupta
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (M.T., P.G.)
- Department of Chemical Pathology and Metabolic Diseases, University Hospitals of Leicester NHS Trust, United Kingdom (P.P., P.G.)
- Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre, University of Leicester, United Kingdom (P.P., P.G.)
| | - Maarten J. Postma
- From the Unit of PharmacoTherapy, -Epidemiology, and -Economics, Department of Pharmacy, University of Groningen, The Netherlands (A.V.v.S., A.D.I.v.A., M.J.P.)
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, The Netherlands (A.D.I.v.A., M.J.P.)
- Department of Health Sciences, University Medical Centre Groningen, University of Groningen, The Netherlands (M.J.P.)
- Department of Economics, Econometrics and Finance, University of Groningen, Faculty of Economics and Business, The Netherlands (M.J.P.)
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Okamura K, Urata H. Anticipated expansion of a new approach to treating hypertension without medication by catheter-based renal denervation. J Thorac Dis 2018; 10:S3266-S3270. [PMID: 30370134 DOI: 10.21037/jtd.2018.08.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Keisuke Okamura
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Hidenori Urata
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Japan
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Avataneo V, De Nicolò A, Rabbia F, Perlo E, Burrello J, Berra E, Pappaccogli M, Cusato J, D'Avolio A, Di Perri G, Veglio F. Therapeutic drug monitoring-guided definition of adherence profiles in resistant hypertension and identification of predictors of poor adherence. Br J Clin Pharmacol 2018; 84:2535-2543. [PMID: 29971815 DOI: 10.1111/bcp.13706] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/01/2018] [Accepted: 06/23/2018] [Indexed: 12/11/2022] Open
Abstract
AIMS Arterial hypertension is an important cardiovascular risk factor. A substantial proportion of patients show resistance to antihypertensive treatment but poor adherence to medication regimens is also a significant cause of treatment failure. In this context, therapeutic drug monitoring (TDM) could be useful. The objective of this study was to assess adherence to treatment in patients with resistant hypertension by TDM and to identify parameters that predict nonadherence. METHODS Liquid chromatography tandem mass spectrometry was used to quantify a wide panel of antihypertensive drugs in human plasma to assess treatment compliance. Associations between TDM-determined adherence profiles, self-reported adherence and other patient-related clinical, anthropometric or demographic features were evaluated as potentially useful pre-TDM predictors of poor adherence. RESULTS TDM was performed on 50 patients with suspected resistant hypertension: 24% of patients partially complied to treatment and 18% were nonadherent. No concordance was observed with questionnaire results, while nonadherence was associated with high diastolic blood pressure, high heart rate, previous onset of stroke and previous use of invasive treatments, including renal denervation or baroreceptor stimulation. CONCLUSIONS This evidence highlights the high prevalence of poor adherence in patients with resistant hypertension and the need for caution in using invasive approaches. These preliminary data require validation in a larger cohort, to confirm the need for TDM in routine clinical practice.
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Affiliation(s)
- Valeria Avataneo
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Amedeo De Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Franco Rabbia
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Elisa Perlo
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Jacopo Burrello
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Elena Berra
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Marco Pappaccogli
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Antonio D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Giovanni Di Perri
- Laboratory of Clinical Pharmacology and Pharmacogenetics#, University of Turin, Turin, Italy.,Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, University of Turin, Turin, Italy.,Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
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Warchol-Celinska E, Prejbisz A, Kadziela J, Florczak E, Januszewicz M, Michalowska I, Dobrowolski P, Kabat M, Sliwinski P, Klisiewicz A, Topor-Madry R, Narkiewicz K, Somers VK, Sobotka PA, Witkowski A, Januszewicz A. Renal Denervation in Resistant Hypertension and Obstructive Sleep Apnea. Hypertension 2018; 72:381-390. [PMID: 29941516 DOI: 10.1161/hypertensionaha.118.11180] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/18/2018] [Accepted: 04/29/2018] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - Jacek Kadziela
- Department of Interventional Cardiology and Angiology (J.K., A.W.)
| | - Elzbieta Florczak
- From the Department of Hypertension (E.W.-C., A.P., E.F., M.K., A.J.)
| | - Magdalena Januszewicz
- Institute of Cardiology, Warsaw, Poland; Second Department of Radiology, Medical University of Warsaw, Poland (M.J.)
| | | | | | - Marek Kabat
- From the Department of Hypertension (E.W.-C., A.P., E.F., M.K., A.J.)
| | - Pawel Sliwinski
- Second Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland (P.S.)
| | - Anna Klisiewicz
- Department of Interventional Cardiology and Angiology (J.K., A.W.)
- Department of Congenital Heart Diseases (P.D., A.K.)
| | - Roman Topor-Madry
- Institute of Public Health, Jagiellonian University Medical College, Cracow, Poland (R.T.-M.)
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.)
| | - Virend K. Somers
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (V.K.S.)
| | - Paul A. Sobotka
- Department of Cardiovascular Diseases, Ohio State University, Columbus (P.A.S.)
- Rox Medical, Inc, San Clemente, CA (P.A.S.)
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Shuey MM, Gandelman JS, Chung CP, Nian H, Yu C, Denny JC, Brown NJ. Characteristics and treatment of African-American and European-American patients with resistant hypertension identified using the electronic health record in an academic health centre: a case-control study. BMJ Open 2018; 8:e021640. [PMID: 29950471 PMCID: PMC6020960 DOI: 10.1136/bmjopen-2018-021640] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify patients with hypertension with resistant and controlled blood pressure (BP) using electronic health records (EHRs) in order to elucidate practices in the real-world clinical treatment of hypertension and to enable future genetic studies. DESIGN Using EHRs, we developed and validated algorithms to identify patients with resistant and controlled hypertension. SETTING An academic medical centre in Nashville, Tennessee. POPULATION European-American (EA) and African-American (AA) patients with hypertension. MAIN OUTCOME MEASURES Demographic characteristics: race, age, gender, body mass index, outpatient BPs and the history of diabetes mellitus, chronic kidney disease stage 3, ischaemic heart disease, transient ischaemic attack, atrial fibrillation and sleep apnoea. MEDICATION TREATMENT All antihypertensive medication classes prescribed to a patient at the time of classification and ever prescribed following classification. RESULTS The algorithms had performance metrics exceeding 92%. The prevalence of resistant hypertension in the total hypertensive population was 7.3% in EA and 10.5% in AA. At diagnosis, AA were younger, heavier, more often female and had a higher incidence of type 2 diabetes and higher BPs than EA. AA with resistant hypertension were more likely to be treated with vasodilators, dihydropyridine calcium channel blockers and alpha-2 agonists while EA were more likely to be treated with angiotensin receptor blockers, renin inhibitors and beta blockers. Mineralocorticoid receptor antagonists use was increased in patients treated with more than four antihypertensive medications compared with patients treated with three (12.4% vs 2.6% in EA, p<0.001; 12.3% vs 2.8% in AA, p<0.001). The number of patients treated with a mineralocorticoid receptor antagonist increased to 37.4% in EA and 41.2% in AA over a mean follow-up period of 7.4 and 8.7 years, respectively. CONCLUSIONS Clinical treatment of resistant hypertension differs in EA and AA patients. These results demonstrate the feasibility of identifying resistant hypertension using an EHR.
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Affiliation(s)
- Megan M Shuey
- Department of Pharmacology, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jocelyn S Gandelman
- Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Cecilia P Chung
- Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Hui Nian
- Department of Biostatistics, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Chang Yu
- Department of Biostatistics, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Nancy J Brown
- Department of Pharmacology, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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34
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Wei FF, Zhang ZY, Huang QF, Staessen JA. Diagnosis and management of resistant hypertension: state of the art. Nat Rev Nephrol 2018; 14:428-441. [DOI: 10.1038/s41581-018-0006-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Anatomical and procedural determinants of ambulatory blood pressure lowering following catheter-based renal denervation using radiofrequency. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:845-851. [PMID: 29555535 DOI: 10.1016/j.carrev.2018.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 02/25/2018] [Accepted: 02/26/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE Catheter-based renal sympathetic denervation (RDN) has been introduced to lower blood pressure (BP) and sympathetic activity in patients with uncontrolled hypertension with at best equivocal results. It has been postulated that anatomic and procedural elements introduce unaccounted variability and yet little is known of the impact of renal anatomy and procedural parameters on BP response to RDN. METHODS/MATERIALS Anatomical parameters such as length and diameter were analyzed by quantitative vascular analysis and the prevalence of accessory renal arteries and renal artery disease were documented in 150 patients with resistant hypertension undergoing bilateral RDN using a mono-electrode radiofrequency catheter (Symplicity Flex, Medtronic). RESULTS Accessory renal arteries and renal artery disease were present in 56 (37%) and 14 patients (9%), respectively. At 6-months, 24 h-ambulatory BP was reduced by 11/6 mm Hg (p < 0.001 for both). Change of systolic blood pressure (SBP) was not related to the presence of accessory renal arteries (p = 0.543) or renal artery disease (p = 0.598). Patients with at least one main renal artery diameter ≤ 4 mm had a more pronounced reduction of 24 h-ambulatory SBP compared to patients where both arteries were >4 mm (-19 vs. -10 mmHg; p = 0.038). Neither the length of the renal artery nor the number of RF ablations influenced 24 h-ambulatory BP reduction at 6 months. CONCLUSIONS 24 h-ambulatory BP lowering was most pronounced in patients with smaller renal artery diameter but not related to renal artery length, accessory arteries or renal artery disease. Further, there was no dose-response relationship observed with increasing number of ablations. CONDENSED ABSTRACT Because little is known of the impact of renal anatomy and procedural parameters on blood pressure (BP) response to renal denervation (RDN), anatomical and procedural data were analyzed in 150 patients undergoing bilateral RDN. BP lowering was most pronounced in patients with smaller renal artery diameter but not related to renal artery length, the presence of renal artery disease or accessory renal arteries. Further, there was no dose-response relationship observed with increasing number of ablations.
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Solomonica A, Lavi S, Choudhury T, Bagur R. Renal denervation therapy beyond resistant hypertension. J Thorac Dis 2018; 10:707-713. [PMID: 29607139 DOI: 10.21037/jtd.2018.01.87] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Amir Solomonica
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Shahar Lavi
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Tawfiq Choudhury
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- London Health Sciences Centre, Western University, London, Ontario, Canada.,Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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38
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Mahfoud F, Schmieder RE, Azizi M, Pathak A, Sievert H, Tsioufis C, Zeller T, Bertog S, Blankestijn PJ, Böhm M, Burnier M, Chatellier G, Durand Zaleski I, Ewen S, Grassi G, Joner M, Kjeldsen SE, Lobo MD, Lotan C, Lüscher TF, Parati G, Rossignol P, Ruilope L, Sharif F, van Leeuwen E, Volpe M, Windecker S, Witkowski A, Wijns W. Proceedings from the 2nd European Clinical Consensus Conference for device-based therapies for hypertension: state of the art and considerations for the future. Eur Heart J 2017; 38:3272-3281. [PMID: 28475773 PMCID: PMC5837218 DOI: 10.1093/eurheartj/ehx215] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/13/2017] [Accepted: 04/06/2017] [Indexed: 01/31/2023] Open
Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Angiologie und Internistische Intensivmedizin, 66421 Homburg, Saar, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Michel Azizi
- Paris-Descartes University, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France
- INSERM, CIC1418, and FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), F-75015 Paris, France
| | - Atul Pathak
- Department of Cardiovascular Medicine, Hypertension, Risk Factors and Heart Failure Unit, Clinique Pasteur, Avenue de Lombez, Toulouse, France
- INSERM 1048, and FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Toulouse, France
| | - Horst Sievert
- CardioVascular Center (CVC), Seckbacher Landstraße, Frankfurt, Germany
- Anglia Ruskin University, Chelmsford, UK
| | - Costas Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | - Thomas Zeller
- Klinik Kardiologie und Angiologie II, Universitaets-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Stefan Bertog
- CardioVascular Center (CVC), Seckbacher Landstraße, Frankfurt, Germany
| | - Peter J Blankestijn
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael Böhm
- Klinik für Innere Medizin III, Saarland University Hospital, Angiologie und Internistische Intensivmedizin, 66421 Homburg, Saar, Germany
| | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland
| | | | - Isabelle Durand Zaleski
- ECEVE, UMR 1123, AP HP URCEco Ile de France Hopital de l’Hotel Dieu, Paris, France
- Sante Publique Hopital Henri Mondor, Creteil, France
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Saarland University Hospital, Angiologie und Internistische Intensivmedizin, 66421 Homburg, Saar, Germany
| | - Guido Grassi
- Clinica Medica, Università Milano-Bicocca, Italy
- IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
| | - Michael Joner
- Deutsches Herzzentrum München, Klinik für Kardiologie, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung e.V., Standort München, Germany
| | - Sverre E Kjeldsen
- ECEVE, UMR 1123, AP HP URCEco Ile de France Hopital de l’Hotel Dieu, Paris, France
- University of Oslo, Institute for Clinical Medicine, Oslo, Norway
| | - Melvin D Lobo
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Chaim Lotan
- Clinica Medica, Università Milano-Bicocca, Italy
| | | | | | - Patrick Rossignol
- INSERM, Centre d’Investigations Cliniques Plurithématique 1433 & U1116, Université de Lorraine, CHRU de Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Luis Ruilope
- Institute of Investigation imas12 and Hypertension Unit, Hospital 12 de Octubre; Department of Preventive Medicine and Public Health, Universidad Autonoma and Department of Postdoctoral Studies and Investigation, Universidad Europea de Madrid, Madrid, Spain
| | - Faisal Sharif
- CURAM, Cardiovascular Research Centre (CVRC) and BioInnovate Ireland, National University of Ireland Galway, Ireland
| | - Evert van Leeuwen
- Department IQ healthcare, section Ethics, Radboudumc, Nijmegen, The Netherlands
| | - Massimo Volpe
- Cardiology, Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome and IRCCS Neuromed, Pozzilli, Italy
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Adam Witkowski
- Department of Interventional Cardiology & Angiology, Institute of Cardiology, Warsaw, Poland
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland
- Saolta University Healthcare Group, Galway, Ireland
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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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de Jager RL, van Maarseveen EM, Bots ML, Blankestijn PJ. Medication adherence in patients with apparent resistant hypertension: findings from the SYMPATHY trial. Br J Clin Pharmacol 2017; 84:18-24. [PMID: 28815689 DOI: 10.1111/bcp.13402] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/03/2017] [Accepted: 08/09/2017] [Indexed: 12/25/2022] Open
Abstract
AIMS Hypertension is only controlled in approximately 35% of the patients, which could be partially due to nonadherence. Recently, bioanalytical assessment of adherence to blood pressure (BP) lowering drugs has gaining interest. Our aim was to explore possible determinants of nonadherence in treatment resistant hypertension, assessed by objective screening for antihypertensive agents in serum. The secondary aim was to study the effect of adherence on the change in BP. METHODS This project was a substudy of SYMPATHY; an open-label randomized-controlled trial to assess the effect of renal denervation on BP 6 months after treatment compared to usual care in patients with resistant hypertension. Stored serum samples were screened for antihypertensive agents to assess adherence at baseline and 6 months after intervention, using liquid chromatography-tandem mass spectrometry. Office and 24-h BP were measured on the same day as blood was sampled. Patients and physicians were unaware of adherence measurements. RESULTS Ninety-eight baseline and 83 6-month samples were available for analysis. Sixty-eight percent [95% confidence interval (CI) 59-78%] of the patients was nonadherent (n = 67). For every onw pill more prescribed, 0.785 [95%CI 0.529-0.891] prescribed pill was less detected in blood. A decrease of one pill in adherence between baseline and 6 months was associated with a significant rise in office systolic BP of 4 (95%CI 0.230-8.932) mmHg. CONCLUSION Objective measurement of BP lowering drugs in serum, as a tool to assess adherence, showed that nonadherence was very common in patients with apparent resistant hypertension. Furthermore, the assessment results were related to (changes in) blood pressure. Our findings provide direct and objective methodology to help the physician to understand and to improve the condition of apparent resistant hypertension.
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Affiliation(s)
- Rosa L de Jager
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erik M van Maarseveen
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel L Bots
- The Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
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Jacobs L, Persu A, Huang QF, Lengelé JP, Thijs L, Hammer F, Yang WY, Zhang ZY, Renkin J, Sinnaeve P, Wei FF, Pasquet A, Fadl Elmula FEM, Carlier M, Elvan A, Wunder C, Kjeldsen SE, Toennes SW, Janssens S, Verhamme P, Staessen JA. Results of a randomized controlled pilot trial of intravascular renal denervation for management of treatment-resistant hypertension. Blood Press 2017; 26:321-331. [DOI: 10.1080/08037051.2017.1320939] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Lotte Jacobs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - 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, Brussels, Belgium
| | - Qi-Fang Huang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jean-Philippe Lengelé
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Department of Nephrology, Grand Hôpital de Charleroi, Gilly, Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Frank Hammer
- Division of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jean Renkin
- 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, Brussels, Belgium
| | - Peter Sinnaeve
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Fang-Fei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Agnès Pasquet
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Marc Carlier
- Department of Cardiology, Grand Hôpital de Charleroi, Gilly, Belgium
| | - Arif Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Cora Wunder
- Department of Forensic Toxicology, Institute of Legal Medicine, University of Frankfurt, Frankfurt, Germany
| | - Sverre E. Kjeldsen
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Stefan W. Toennes
- Department of Forensic Toxicology, Institute of Legal Medicine, University of Frankfurt, Frankfurt, Germany
| | - Stefan Janssens
- Division of Cardiology, Department Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verhamme
- Division of Cardiology, Department Internal Medicine, University Hospitals Leuven, Leuven, Belgium
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan A. Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
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de Jager RL, de Beus E, Beeftink MM, Sanders MF, Vonken EJ, Voskuil M, van Maarseveen EM, Bots ML, Blankestijn PJ. Impact of Medication Adherence on the Effect of Renal Denervation. Hypertension 2017; 69:678-684. [DOI: 10.1161/hypertensionaha.116.08818] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 12/13/2016] [Accepted: 01/17/2017] [Indexed: 01/01/2023]
Abstract
Randomized trials of catheter-based renal denervation (RDN) as therapy for resistant hypertension showed conflicting results in blood pressure (BP) lowering effect. Adherence to medication is modest in this patient group and may importantly drive these conflicting results. SYMPATHY is a prospective open label multicenter trial in Dutch patients with resistant hypertension. Primary outcome was change in daytime systolic ambulatory BP at 6 months. Patients were randomly assigned to RDN on top of usual care. Adherence to BP lowering drugs was assessed at baseline and follow-up, using blood samples drawn synchronously with BP measurements. Patients and physicians were unaware of the adherence assessment. Primary analyses showed a mean difference between RDN (n=95) and control (n=44) in changes in daytime systolic ambulatory BP after 6 months of 2.0 mm Hg (95% confidence interval, −6.1 to 10.2 mm Hg) in favor of control. In 80% of patients, fewer medications were detected than prescribed and adherence changed during follow-up in 31%. In those with stable adherence during follow-up, mean difference between RDN and control for daytime systolic ambulatory BP was −3.3 mm Hg (−13.7 to 7.2 mm Hg) in favor of RDN. RDN as therapy for resistant hypertension was not superior to usual care. Objective assessment of medication use shows that medication adherence is extremely poor, when patients are unaware of monitoring. Changes over time in adherence are common and affect treatment estimates considerably. Objective measurement of medication adherence during follow-up is strongly recommended in randomized trials.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01850901.
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Affiliation(s)
- Rosa L. de Jager
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Esther de Beus
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Martine M.A. Beeftink
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Margreet F. Sanders
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Evert-Jan Vonken
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Michiel Voskuil
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Erik M. van Maarseveen
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Michiel L. Bots
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Peter J. Blankestijn
- From the Department of Nephrology and Hypertension (R.L.d.J., E.d.B., M.F.S., P.J.B.), Department of Cardiology (M.M.A.B., M.V.), Department of Radiology (E.-J.V.), Department of Clinical Pharmacy (E.M.v.M.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, The Netherlands
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Abbas H, Kurdi M, Watfa M, Karam R. Adherence to treatment and evaluation of disease and therapy knowledge in Lebanese hypertensive patients. Patient Prefer Adherence 2017; 11:1949-1956. [PMID: 29238170 PMCID: PMC5713687 DOI: 10.2147/ppa.s142453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adherence to treatment, healthy lifestyle, physical activities, smoking, diet, and salt intake are important factors to control for an effective decrease in blood pressure (BP) values for patients diagnosed with essential hypertension (HT). The aim of this work was to study the adherence to antihypertensive treatment and factors predicting this behavior in Lebanese patients. In addition, we evaluated the extent of patient's knowledge and perceptions about HT, risk factors, and medication side effects. METHODS The cross-sectional study was conducted between May and September 2015 among 249 participants randomly recruited from community and hospital pharmacies (56.6%), private cardiology clinics (37%), and outpatient clinics located in hospitals (6.4%) in Baabda region of Lebanon. The questionnaire was prepared after reviewing published literature. Data were collected by trained and certified interviewers and analyzed by Statistical Package for the Social Sciences program. p-value less than 0.05 was considered to determine the statistical significance. RESULTS Among the 249 patients interviewed, 48% were females with a mean age of 62±17.2 years. Overweight and obesity was declared in 42.2% and 35.3%, respectively. Only 52.6% of participants reported visiting their physicians for regular checkups, and 72% claimed checking their BP routinely at home. Awareness of complications related to HT was very high (97%). However, our results showed that 89.2% of the participants were found to be adherent to treatment, and forgetfulness was cited as the main reason for non-adherence to therapy. Only health coverage showed statistical significance (p=0.01) between adherent and non-adherent participants. CONCLUSION A better communication between patients and their physicians, the use of a special container for medication packaging, and reminder to refill prescriptions are important parameters to enhance adherence to treatment. HT can be better managed if an educational system is implemented to increase awareness.
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Affiliation(s)
- Hanine Abbas
- Department of Chemistry and Biochemistry, Faculty of Science, Lebanese University
| | - Mazen Kurdi
- Department of Chemistry and Biochemistry, Faculty of Science, Lebanese University
| | - Myriam Watfa
- Quality Assurance of Pharmaceutical Products Department, Lebanese Ministry of Public Health
| | - Rita Karam
- Department of Chemistry and Biochemistry, Faculty of Science, Lebanese University
- Quality Assurance of Pharmaceutical Products Department, Lebanese Ministry of Public Health
- Pharmacology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Correspondence: Rita Karam, Faculty of Sciences, Section 1, Lebanese University, Beirut, Lebanon, Tel +961 3 77 5061, Email
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Blood pressure response to catheter-based renal sympathetic denervation in severe resistant hypertension: data from the Greek Renal Denervation Registry. Clin Res Cardiol 2016; 106:322-330. [DOI: 10.1007/s00392-016-1056-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/22/2016] [Indexed: 12/28/2022]
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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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Ewen S, Ukena C, Lüscher TF, Bergmann M, Blankestijn PJ, Blessing E, Cremers B, Dörr O, Hering D, Kaiser L, Nef H, Noory E, Schlaich M, Sharif F, Sudano I, Vogel B, Voskuil M, Zeller T, Tzafriri AR, Edelman ER, Lauder L, Scheller B, Böhm M, Mahfoud F. Anatomical and procedural determinants of catheter-based renal denervation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:474-479. [PMID: 27617388 DOI: 10.1016/j.carrev.2016.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/12/2016] [Accepted: 08/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Catheter-based renal sympathetic denervation (RDN) can reduce blood pressure (BP) and sympathetic activity in certain patients with uncontrolled hypertension. Less is known about the impact of renal anatomy and procedural parameters on subsequent BP response. METHODS/MATERIALS A total of 564 patients with resistant hypertension underwent bilateral RDN in 9 centers in Europe and Australia using a mono-electrode radiofrequency catheter (Symplicity Flex, Medtronic). Anatomical criteria such as prevalence of accessory renal arteries (ARA), presence of renal artery disease (RAD), length, and diameter were analyzed blinded to patient's characteristics. RESULTS ARA was present in 171 patients (30%), and RAD was documented in 71 patients (13%). On average 11±2.7 complete 120-s ablations were performed, equally distributed on both sides. After 6months, BP was reduced by 19/8mmHg (p<0.001 for both). Change of systolic blood pressure (SBP) was not related to the presence of ARA (-18 vs. -20mmHg; p=NS) or RAD (-16 vs. -20mmHg; p=NS). Patients with a bilateral diameter≤4mm had a more pronounced reduction of SBP compared to patients with a unilateral diameter≤4mm or a bilateral diameter>4mm (-29 vs. -26 vs. -17mmHg; p<0.001). Neither the length of the renal artery nor the number of RF ablations influenced BP reduction after 6months. CONCLUSIONS The diameter of renal arteries correlated with SBP change after RDN at 6-month follow-up. Change of SBP was not related to the lengths of the renal artery, presence of ARA, RAD, or the number of RF ablations delivered by a mono-electrode catheter.
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Affiliation(s)
- Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | | | | | - Peter J Blankestijn
- Department of Nephrology, University Medical Center, Utrecht, the Netherlands
| | - Erwin Blessing
- Medizinische Klinik III, Universitätsklinikum Heidelberg, Germany
| | - Bodo Cremers
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Oliver Dörr
- Medizinische Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinikum, Gießen, Germany
| | - Dagmara Hering
- Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia
| | - Lukas Kaiser
- Kardiologie, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Holger Nef
- Medizinische Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinikum, Gießen, Germany
| | - Elias Noory
- Angiologie, Universitätsherzzentrum, Bad Krozingen, Germany
| | - Markus Schlaich
- Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia
| | | | - Isabella Sudano
- Kardiologie, Universitäres Herzzentrum, Universitätsspital, Zürich, Switzerland
| | - Britta Vogel
- Medizinische Klinik III, Universitätsklinikum Heidelberg, Germany
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center, Utrecht, the Netherlands
| | - Thomas Zeller
- Angiologie, Universitätsherzzentrum, Bad Krozingen, Germany
| | - Abraham R Tzafriri
- Institute for Medical Engineering and Science, MIT, Cambridge MA and Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, MIT, Cambridge MA and Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Bruno Scheller
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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Neumann JT, Ewen S, Mortensen K, Nef H, Zeller T, Ojeda F, Sydow K, Mahfoud F, Böhm M, Hamm C, Dörr O, Blankenberg S. Effects of renal denervation on heart failure biomarkers and blood pressure in patients with resistant hypertension. Biomark Med 2016; 10:841-51. [DOI: 10.2217/bmm-2016-0098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This multicenter study investigated the effect of renal denervation therapy (RDN) on the heart failure related biomarkers NT-proBNP, ST-2, galectin-3 and hs-TnI. Patients & methods: We included 157 patients with resistant hypertension undergoing RDN. Blood sampling was performed before and 6 months after RDN. Results: Six months after RDN systolic blood pressure (BP) was reduced by 24 mmHg. Biomarker concentrations were not changed after RDN, except a small increase of hs-TnI by 0.3 pg/ml. In individuals with high baseline BP, we observed a BP reduction of 45 mmHg and a decrease of hs-TnI concentrations by 1.2 pg/ml. Conclusion: In this multicenter analysis RDN did significantly reduce systolic BP. However, NT-proBNP, ST-2, galectin-3 and hs-TnI did not correspond to BP reduction 6 months after RDN.
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Affiliation(s)
- Johannes Tobias Neumann
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung e.V. (DZHK), Partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universität des Saarlandes, Homburg/Saar, Germany
| | - Kai Mortensen
- Klinik für Innere Medizin II, Kardiologie, Universität Lübeck, Lübeck, Germany
| | - Holger Nef
- Klinik für Innere Medizin I, Kardiologie/Angiologie, Universität Giessen, Giessen, Germany
| | - Tanja Zeller
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung e.V. (DZHK), Partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Francisco Ojeda
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - Karsten Sydow
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universität des Saarlandes, Homburg/Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universität des Saarlandes, Homburg/Saar, Germany
| | - Christian Hamm
- Klinik für Innere Medizin I, Kardiologie/Angiologie, Universität Giessen, Giessen, Germany
| | - Oliver Dörr
- Klinik für Innere Medizin I, Kardiologie/Angiologie, Universität Giessen, Giessen, Germany
| | - Stefan Blankenberg
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung e.V. (DZHK), Partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
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49
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Maurer HH, Meyer MR. High-resolution mass spectrometry in toxicology: current status and future perspectives. Arch Toxicol 2016; 90:2161-2172. [PMID: 27369376 DOI: 10.1007/s00204-016-1764-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Abstract
This paper reviews high-resolution mass spectrometry (HRMS) approaches using time-of-flight or Orbitrap techniques for research and application in various toxicology fields, particularly in clinical toxicology and forensic toxicology published since 2013 and referenced in PubMed. In the introduction, an overview on applications of HRMS in various toxicology fields is given with reference to current review articles. Papers concerning HRMS in metabolism, screening, and quantification of pharmaceuticals, drugs of abuse, and toxins in human body samples are critically reviewed. Finally, a discussion on advantages as well as limitations and future perspectives of these methods is included.
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Affiliation(s)
- H H Maurer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University, 66421, Homburg, Saar, Germany.
| | - Markus R Meyer
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
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50
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Mahfoud F, Ewen S, Böhm M. Renal denervation in patients with heart failure with preserved ejection fraction: end of the beginning? Eur J Heart Fail 2016; 18:713-5. [DOI: 10.1002/ejhf.553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 01/01/2023] Open
Affiliation(s)
- Felix Mahfoud
- Klink für Innere Medizin III Saarland University Hospital Homburg/Saar Germany
| | - Sebastian Ewen
- Klink für Innere Medizin III Saarland University Hospital Homburg/Saar Germany
| | - Michael Böhm
- Klink für Innere Medizin III Saarland University Hospital Homburg/Saar Germany
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