Journal
HYPERTENSION
Volume 79, Issue 1, Pages 12-23Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/HYPERTENSIONAHA.121.17596
Keywords
adherence; guidelines; hypertension; mass spectrometry; compliance; urine
Categories
Funding
- British Heart Foundation Clinical Study Grant [CS/17/3/32799]
- National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM)
Ask authors/readers for more resources
Nonadherence to antihypertensive medication is common, and chemical adherence testing is a reliable method to detect nonadherence, especially in patients with apparent treatment-resistant hypertension. Testing should be done in specific situations, such as in those with resistant hypertension or those on multiple antihypertensives with inadequate blood pressure control. Verbal consent should be obtained before testing, and results should be discussed with the patient for better understanding.
Nonadherence to antihypertensive medication is common, especially in those with apparent treatment-resistant hypertension (true treatment-resistant hypertension requires exclusion of nonadherence), and its routine detection is supported by clinical guidelines. Chemical adherence testing is a reliable and valid method to detect adherence, yet methods are unstandardized and are not ubiquitous. This article describes the principles of chemical adherence testing for hypertensive patients and provides a set of recommendations for centers wishing to develop the test. We recommend testing should be done in either of two instances: (1) in those who have resistant hypertension or (2) in those on 2 antihypertensives who have a less than 10 mm Hg drop in systolic blood pressure on addition of the second antihypertensive medication. Furthermore, we recommend that verbal consent is secured before undertaking the test, and the results should be discussed with the patient. Based on medications prescribed in United Kingdom, European Union, and United States, we list top 20 to 24 drugs that cover >95% of hypertension prescriptions which may be included in the testing panel. Information required to identify these medications on mass spectrometry platforms is likewise provided. We discuss issues related to ethics, sample collection, transport, stability, urine versus blood samples, qualitative versus quantitative testing, pharmacokinetics, instrumentation, validation, quality assurance, and gaps in knowledge. We consider how to best present, interpret, and discuss chemical adherence test results with the patient. In summary, this guidance should help clinicians and their laboratories in the development of chemical adherence testing of prescribed antihypertensive drugs.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available