Cora Wunder1, Alexandre Persu2,3, Jean-Philippe Lengelé2,4, Coralie Mg Georges2, Jean Renkin2,3, Agnès Pasquet2, Marc Carlier5, Zhen-Yu Zhang6, Jan A Staessen6,7. 1. a Institute of Legal Medicine, Goethe-University Frankfurt , Frankfurt , Germany. 2. b Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium. 3. c Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique , Université Catholique de Louvain , Brussels , Belgium. 4. d Department of Nephrology , Grand Hôpital de Charleroi , Gilly , Belgium. 5. e Department of Cardiology , Grand Hôpital de Charleroi , Gilly , Belgium. 6. f Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium. 7. g Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , The Netherlands.
Abstract
PURPOSE: Drug adherence may be a major problem in the therapy of hypertension and in the diagnosis of therapy resistance. Adherence can be assessed by indirect methods or by direct methods like drug detection in urine with liquid chromatography-mass spectrometric methods. MATERIALS AND METHODS: The current analysis included patients with apparently treatment- resistant hypertension (TRH) referred for renal denervation (RDN) and included in the the INSPiRED pilot trial (NCT01505010). Adherence was repeatedly assessed by toxicological urine analysis over a time range of up to 17 months in a total of 18 patients. RESULTS: In the first urine samples of 18 patients the adherence rate (percentage of number of detected vs. prescribed medical drugs) ranged from 0 to 100% with a median of 73.2%. In further urine samples collected during the following up to 17 months every individual patient exhibited considerable changes in the adherence rate, neither a constancy nor a tendency could be deduced. CONCLUSIONS: Urine analysis results exhibit variation over time and an assessment at a certain time point cannot be regarded as representative or predictor for future behavior. Therefore, it appears necessary to perform drug adherence testing repeatedly over time.
PURPOSE: Drug adherence may be a major problem in the therapy of hypertension and in the diagnosis of therapy resistance. Adherence can be assessed by indirect methods or by direct methods like drug detection in urine with liquid chromatography-mass spectrometric methods. MATERIALS AND METHODS: The current analysis included patients with apparently treatment- resistant hypertension (TRH) referred for renal denervation (RDN) and included in the the INSPiRED pilot trial (NCT01505010). Adherence was repeatedly assessed by toxicological urine analysis over a time range of up to 17 months in a total of 18 patients. RESULTS: In the first urine samples of 18 patients the adherence rate (percentage of number of detected vs. prescribed medical drugs) ranged from 0 to 100% with a median of 73.2%. In further urine samples collected during the following up to 17 months every individual patient exhibited considerable changes in the adherence rate, neither a constancy nor a tendency could be deduced. CONCLUSIONS: Urine analysis results exhibit variation over time and an assessment at a certain time point cannot be regarded as representative or predictor for future behavior. Therefore, it appears necessary to perform drug adherence testing repeatedly over time.
Authors: Joanne Simpson; Colette E Jackson; Caroline Haig; Pardeep S Jhund; Maciej Tomaszewski; Roy S Gardner; Yannis Tsorlalis; Mark C Petrie; John J V McMurray; Iain B Squire; Pankaj Gupta Journal: Eur Heart J Cardiovasc Pharmacother Date: 2021-07-23