NSG 6999 W6 D15 -Resistant Hypertensive Patients

NSG 6999 W6 D15 -Resistant Hypertensive Patients

NSG 6999 W6 D15 -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.

 

Support Synthesis

One major modifiable factor in uncontrolled, or resistant, hypertension is patient adherence to prescribed antihypertensive therapy.  Recent studies demonstrate a rate of partial or complete nonadherence to HTN therapy between 25% to 65% (Gupta et al., 2017; Tomaszewski et al., 2014).  However, after successful screening using high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS), rates of adherence with prescribed antihypertensive therapy increased by nearly 80% and 53% converted to full compliance (Gupta et al., 2017).

Nonadherent patients initially present with higher systolic and diastolic blood pressures, but after screening and education, nonadherent blood pressures were statistically comparable to those of initially adherent patients (Gupta et al., 2017; Tomaszewski et al., 2014).  Critics tout against the cost of HP LC-MS/MS screening, however the cost of nonadherence far exceeds that of a simple urine or serum test.  Patients unresponsive to standard antihypertensive therapy undergo a multitude of additional tests and procedures that adds up to nearly $18.5 million annually in the United States (US) (Gupta et al., 2017; Tomaszewski et al., 2014).  Additionally, HTN control is associated with the reduced risk of kidney disease, stroke, myocardial infarction, and heart failure, further reducing the overall healthcare burden (Gupta et al., 2017).

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References

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

1. J. (2017). 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

 

Tomaszewski, M., White, C., Patel, P., Masca, N., Damani, W., Hepworth, J., . . .&

Williams, B. (2014). High rates of non-adherence to antihypertensive treatment

revealed by high-performance liquid chromatography-tandem mass spectrometry

(HP LC-MS/MS) urine analysis. Heart, 100, 855-861. doi: 10.1136/heartjnl-2013-

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