7B.06: ROUTINE URINARY DETECTION OF ANTIHYPERTENSIVE DRUGS FOR ESTIMATION OF ADHERENCE TO TREATMENT. (June 2015)

• Record Type: Journal Article
• Authors: Hamdidouche, I.; Jullien, V.; Billaud, E.M.; Boutouyrie, P.; Azizi, M.; Laurent, S.
• Is Part Of: Journal of hypertension. Volume 33(2015)Supplement 1
• Publication Date: 2015-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000467603.33785.69
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Adherence to antihypertensive treatment (AHT) is usually assessed by scales such as Morisky Medication Adherence Scale questionnaire (MMAS-4) but objective urinary drug levels quantification by liquid chromatography mass spectrometry (LCMS-MS) is now available. Our aim was to compare adherence assessed by LCMS-MS or MMAS-4, in patients with resistant hypertension (RH), compared to patients with well controlled hypertension (CH). Design and method: RH cohort consisted in 82 patients with daytime ABPM > 135/85 mmHg after 4 weeks treatment with a standardised triple AHT participating to a clinical trial. The CH cohort consisted in 91 patients followed in a routine care practice with controlled office BP (<140/90 mmHg) by a median of 2 (range 1–4) AHT. Urinary levels of 14 AHT or their metabolites were evaluated by LC/MS-MS. MMAS-4 was only available in CH. Patients were aware (RH) or not (CH) of the measurement. Non-adherence was defined as a urinary level of at least one AHT below the limit of quantification. Results: LCMS-MS results: in the RH cohort, 63 patients (77%) were adherent, 11 (13%) were partly non-adherent and 8 (10%) were fully non-adherent. In the CH cohort, 86 (93%) were adherent, 5 (6%) were partly non-adherent, and 1 (1%) was fully non-adherent. Office SBP in the CH cohort was significantly higher in non-adherent (partially or fully) than in fully adherent patients (median: 140 vs. 130 mmHg, respectively; p = 0.01). Office DBP did not differ. According to LCMS-MS, the full adherence rate was significantly higher in CH compared to RH cohort (p = 0.002). According to MMAS-4 available in 88 CH patients, 76 (86%) were fully adherent, and 12 (14%) were medium or low adherent and no significant difference in office SBP/DBP was observed between the two subgroups. There was low or no agreement between LCMS-MS and MMAS-4, with 15/88 non concordant tests. Conclusions: In conclusion, measurement of urinary AHT by LCMS-MS gives relevant information on adherence to treatment in patients attending an outpatient clinic. This information is not overlapping with questionnaire tests. It confirms the role of objective non-adherence to treatment in resistance to treatment.