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Peeters LE, Kappers M, Hesselink D, van der Net J, Hartong S, van de Laar R, Ezzahti M, van de Ven P, van der Meer I, de Bruijne E, Kroon A, Indhirajanti-Tomasoa S, van der Linde N, Bahmany S, Boersma E, Massey EK, van Dijk L, van Gelder T, Koch BC, Versmissen J. Antihypertensive drug concentration measurement combined with personalized feedback in resistant hypertension: a randomized controlled trial. J Hypertens 2024; 42:169-178. [PMID: 37796233 PMCID: PMC10713002 DOI: 10.1097/hjh.0000000000003585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Adherence to antihypertensive drugs (AHDs) is crucial for controlling blood pressure (BP). We aimed to determine the effectiveness of measuring AHD concentrations using a dried blood spot (DBS) sampling method to identify nonadherence, combined with personalized feedback, in reducing resistant hypertension. METHODS We conducted a multicenter, randomized, controlled trial (RHYME-RCT, ICTRP NTR6914) in patients with established resistant hypertension. Patients were randomized to receive either an intervention with standard of care (SoC) or SoC alone. SoC consisted of BP measurement and DBS sampling at baseline, 3 months (t3), 6 months (t6), and 12 months (t12); AHD concentrations were measured but not reported in this arm. In the intervention arm, results on AHD concentrations were discussed during a personalized feedback conversation at baseline and t3. Study endpoints included the proportion of patients with RH and AHD adherence at t12. RESULTS Forty-nine patients were randomized to receive the intervention+SoC, and 51 were randomized to receive SoC alone. The proportion of adherent patients improved from 70.0 to 92.5% in the intervention+SoC arm ( P = 0.008, n = 40) and remained the same in the SoC arm (71.4%, n = 42). The difference in adherence between the arms was statistically significant ( P = 0.014). The prevalence of resistant hypertension decreased to 75.0% in the intervention+SoC arm ( P < 0.001, n = 40) and 59.5% in the SoC arm ( P < 0.001, n = 42) at t12; the difference between the arms was statistically nonsignificant ( P = 0.14). CONCLUSION Personalized feedback conversations based on DBS-derived AHD concentrations improved AHD adherence but did not reduce the prevalence of RH.
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Affiliation(s)
- Laura E.J. Peeters
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | | | - D.A. Hesselink
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | - J.B. van der Net
- Albert Schweitzer Hospital, Department of Internal Medicine, Dordrecht
| | - S.C.C. Hartong
- Albert Schweitzer Hospital, Department of Internal Medicine, Dordrecht
| | - R. van de Laar
- Ikazia Hospital, Department of Internal Medicine, Rotterdam
| | - M. Ezzahti
- Bravis Hospital, Department of Internal Medicine, Bergen op Zoom
| | | | | | - E.L.E. de Bruijne
- IJsselland Hospital, Department of Internal Medicine, Capelle aan den Ijssel
| | - A.A. Kroon
- Maastricht University Medical Center, Department of Internal Medicine, Maastricht
| | | | | | - S. Bahmany
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy
| | - E. Boersma
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam
| | - E. K. Massey
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | - L. van Dijk
- Nivel, Netherlands Institute for Health Services Research, Department Pharmaceutical Care, Utrecht
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - T. van Gelder
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | - Birgit C.P. Koch
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | - Jorie Versmissen
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
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Klop B, Hartong S, Vermeer H, Schoofs M, Willemsen S, Van Den Bos E, Kofflard M. P636Risk of misclassification with a non-fasting lipid profile in secondary cardiovascular prevention. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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