Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Nov;70(5):1042-1048.
doi: 10.1161/HYPERTENSIONAHA.117.09631. Epub 2017 Aug 28.

Biochemical Screening for Nonadherence Is Associated With Blood Pressure Reduction and Improvement in Adherence

Pankaj Gupta  1 , Prashanth Patel  1 , Branislav Štrauch  1 , Florence Y Lai  1 , Artur Akbarov  1 , Gaurav S Gulsin  1 , Alison Beech  1 , Věra Marešová  1 , Peter S Topham  1 , Adrian Stanley  1 , Herbert Thurston  1 , Paul R Smith  1 , Robert Horne  1 , Jiří Widimský  1 , Bernard Keavney  1 , Anthony Heagerty  1 , Nilesh J Samani  1 , Bryan Williams  1 , Maciej Tomaszewski  2
Affiliations

Biochemical Screening for Nonadherence Is Associated With Blood Pressure Reduction and Improvement in Adherence

Pankaj Gupta et al. Hypertension. 2017 Nov.

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.

Keywords: adherence; antihypertensive agents; blood pressure; chromatography, liquid; hypertension.

PubMed Disclaimer

Figures

Figure.
Figure.
Association between changes in blood pressure and urinary adherence ratio in initially nonadherent patients. X axis represents the change in urinary adherence ratio (the ratio of detected to prescribed antihypertensive medications), y axis represents the change in clinic blood pressure (BP; mm Hg), data points are changes in BP and urinary adherence ratio between the appointments with complete information (both BP and adherence) available, P value indicates level of statistical significance for association between the change in urinary adherence ratio and change in systolic BP (SBP) and diastolic BP (DBP).
See this image and copyright information in PMC

References

    1. WHO. A global brief on hypertension. who.int/cardiovascular_diseases/publications/global_brief_hypertension. Accessed January 16, 2017.
    1. Neal B, MacMahon S, Chapman N Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet. 2000;356:1955–1964. - PubMed
    1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr, Jones DW, Materson BJ, Oparil S, Wright JT, Jr, Roccella EJ National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–2572. doi: 10.1001/jama.289.19.2560. - PubMed
    1. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665. - PMC - PubMed
    1. Kotseva K, Wood D, De Bacquer D, et al. EUROASPIRE Investigators. EUROASPIRE IV: a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol. 2016;23:636–648. doi: 10.1177/2047487315569401. - PubMed

MeSH terms