NSG6999 W5 D16 – Resistant Hypertensive Patients

NSG6999 W5 D16 – Resistant Hypertensive Patients

NSG6999 W5 D16 – Resistant Hypertensive Patients

PICOT:  In resistant hypertensive patients, screening with liquid chromatography-tandem mass spectrometry (LC-MS/MS) when compared with self-disclosed adherence, improves blood pressure control and is cost effective as a compliment to optimum standard medication therapy.

 

Azizi, M., Periera, H., Hamdidouche, I., Monge, M., Bobrie, G., Delsart, P., . . .&

Chatellier, G. (2016). Adherence to antihypertensive treatment and the blood

pressure-lowering effects of renal denervation in the Renal Denervation for

Hypertension (DENERHTN) trial. Circulation, 134(12), 847-857.10.1161/

CIRCULATIONAHA.116.022922

 

Why was the study done? Azizi et al. (2016) conducted their study to determine the affect of adherence to prescribed antihypertensive treatment on blood pressure (BP) control.

 

What is the sample size?  The authors used information and resources from the Renal Denervation for Hypertension (DENERHTN) trial for their data.  In total, 85 patients were screened for medication adherence.

 

Are instruments of the variables in the study clearly defined and reliable? Adherence to antihypertensive medications was measured using urine or serum ultrahigh performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) or, specifically for the detection of ramipril, urine N-acetyl-seryl-aspartyl-lysyl-proline/creatinine (AcSDKP/creatinine).  All prescribed medications had to be detected in urine samples to be considered fully adherent.

 

Blood pressure measurements were conducted at home on BP devices provided by the research team.  All patients were treated based upon home BP readings using the standardized stepped antihypertensive treatment (SSAHT) protocol, no alternate BP medications were permitted during the trial.

 

How was the data analyzed?  Data for the 2 groups, renal denervation and control group, were compared using the Fisher exact and unpaired t test. Comparison of BPs was analyzed via covariance with the use of SAS software.  Significance was determined by a P < 0.05.

NSG6999 W5 D16 – Resistant Hypertensive Patients

Were there any unusual events during the study?  No abnormal or unexpected events were reported by the researchers.

 

How did the results fit in with the previous research in this area?  The overall number of medications detected vice prescribed was less in both groups (renal denervation with SSAHT and SSAHT only) with no significant differences between the groups.  Full compliance with prescribed medications was also similar in both the renal denervation and SSAHT group (50% and 46%, respectively).  Compliant patients saw an average of 4 to 5 point higher drop in daytime systolic blood pressure when compared to those who were noncompliant.

 

Research in the use of LC-MS/MS to screen for antihypertensive therapy compliance is still in its proverbial infancy.  However, this study reports adherence rates, as measured by the use of LC-MS/MS, similar to four other studies conducted in England, Germany, the Czech Republic, and the United States (Brinker et al., 2014; Gupta et al., 2017; Jung et al., 2013; Lawson et al., 2016).

 

What are the implications of the research for clinical practice?  This study reinforces the need for objective screening for medication compliance in seemingly resistant hypertension prior to more invasive procedures.  Even in the highly controlled environment of a randomized controlled trial, nearly half of all participants were not compliant with prescribed therapies.  Such nonadherence contributes to an exceedingly large waste of medical and financial resources.

Brinker, S., Pandey, A., Ayers, C., Price, A., Raheja, P., Arbique, D., . . .&

Vongpatanasin (2014). Therapeutic drug monitoring facilitates blood pressure

control in resistant hypertension. Journal of the American College of Cardiology,

63(8), 834-835. doi: 10.1016/j.jacc.2013.10.067

Gupta, P., Patel, P., Strauch, B., Lai, F. Y., Akbarov, A., Gulsin, G. S., . . .Tomaszewski,

1. J. (2017a). Biochemical screening for nonadherence is associated with blood

pressure reduction and improvement in adherence. Hypertension, 70(1), 1042-

1048. doi: 10.1161/HYPERTENSIONAHA.117.09631

Jung, O., Gechter, J. L., Wunder, C., Palke, A., Bartel, C., Geiger, H., & Toennes, S.

1. (2013). Resistant hypertension? Assessment of adherence by toxicological

urine analysis. Journal of Hypertension, 31(4), 766-799. doi: 10.1097/HJH.

0b013e32835e2286

Lawson, A. J., Shipman, K. E., George, S, & Dasgupta, I. (2016). A novel ‘dilute-and-

shoot’ liquid chromatography-tandem mass spectrometry method for screening

of antihypertensive drugs in urine. Journal of Analytical Toxicology, 40(1), 17-

27. doi: 10.1093/jat/bkv102

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