ESTIMATE OF ANTI-HYPERTENSIVE DRUG ADHERENCE THROUGH SERIAL MEASUREMENTS OF ALDOSTERONE-TO-RENIN RATIO. (June 2022)

• Record Type: Journal Article
• Authors: Buffolo, Fabrizio; Sconfienza, Elisa; Burrello, Jacopo; Losano, Isabel; Mengozzi, Giulio; Priolo, Gabriella; Avataneo, Valeria; D'Avolio, Antonio; Veglio, Franco; Rabbia, Franco; Mulatero, Paolo; Monticone, Silvia
• Is Part Of: Journal of hypertension. Volume 40(2022)Supplement 1
• Page Start: e311
• Publication Date: 2022-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000838772.03800.3c
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Inadequate adherence to anti-hypertensive prescription is one of the major obstacles for blood pressure control in patients with arterial hypertension. It is estimated that 40% of patients with hypertension have partial or absent compliance, with more than 80% of non-adherence when blood pressure targets are not achieved. However, in clinical practice the assessment of therapeutic adherence is still challenging. The available methods for the assessment of anti-hypertensive compliance are costly, low accurate or time consuming. Design and method: We designed a prospective observational study to evaluate the therapeutic adherence to inhibitors of renin-angiotensin-aldosterone system (RAAS) in patients with hypertension through serial measurement of aldosterone-to-direct renin ratio (ARR), before and after treatment. We enrolled 80 patients, including 40 patients with arterial hypertension and 40 healthy controls. Patients with arterial hypertension underwent three visits: at baseline and 2 and 8 weeks after initiation of RAAS inhibitors. Patients of the control group underwent two visits: at baseline and after 2 weeks. At each visit we collected blood specimens for hormonal assays and therapeutic drug monitoring, used as gold standard for therapeutic adherence. We used delta ARR (ARR), defined as the relative change in ARR before and after treatment, for assessment of therapeutic compliance. Results: After initiation of RAAS inhibitor, aldosterone significantly decreased and renin levels significantly increased, with consequent ARR reduction. The use ARR provided high accuracy for determination of therapeutic compliance, with an area under the curve (AUC) of 0.900 and 0.886, at 2 and 8 weeks respectively. A cut-off of -48% of ARR was adopted, providing 90% sensitivity and 75% specificity, both at 2 and 8 weeks. Conclusions: The ARR measurement, is an innovative, cheap and highly sensitive method to predict compliance to RAAS inhibitors in patients with hypertension. We hence propose the implementation of ARR as screening test for identification of patients suspected to be non-adherent, reserving therapeutic drug monitoring for non-adherence confirmation.