Major disparities in patient-reported adherence compared to objective assessment of adherence using mass spectrometry: A prospective study in a tertiary-referral hypertension clinic.

Autor: Curneen JMG; Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland Galway, Galway, Ireland., Rabbitt L; Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland Galway, Galway, Ireland., Browne D; Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland Galway, Galway, Ireland., O'Donoghue DF; Department of Nephrology, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland., Alansari Y; Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland., Harhen B; Discipline of Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland., Ní Ghríofa A; Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland., Ferguson J; Discipline of Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland., McEvoy JW; Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland Galway, Galway, Ireland.; Department of Cardiology, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland., Lappin D; Department of Nephrology, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland.; Discipline of Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland., Finn DP; Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland Galway, Galway, Ireland.; Discipline of Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland., O'Shea PM; Discipline of Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland.; Department of Clinical Biochemistry, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland., Dennedy MC; Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland Galway, Galway, Ireland.; Discipline of Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland.
Jazyk: angličtina
Zdroj: British journal of clinical pharmacology [Br J Clin Pharmacol] 2023 Jul; Vol. 89 (7), pp. 1948-1955. Date of Electronic Publication: 2022 Mar 25.
DOI: 10.1111/bcp.15292
Abstrakt: Aim: Many challenges exist in determining true rates of adherence to antihypertensive medications among individuals in a clinic setting. For the first time, we aimed to compare patient-reported antihypertensive adherence with objective evidence using mass spectrometry spot urinalysis in a tertiary referral clinic setting.
Methods: A prospective observational single-centre cohort study was performed in a tertiary referral hypertension clinic, encompassing antihypertensive initiation and persistence. Patients were referred with apparent treatment-resistant hypertension or for suspected secondary causes. Participants completed a self-reported assessment of antihypertensive adherence and provided a spot urine sample. The presence of antihypertensive medications and/or their respective metabolites was evaluated using high-performance liquid chromatography tandem mass spectrometry. Patients were determined to be adherent if they demonstrated both self-reported adherence and objective mass spectrometry evidence.
Results: Of all 105 eligible participants initially recruited, 73 (69.5%) met the eligibility criteria. Only 27.4% (95% confidence interval 0.2-0.4) of participants demonstrated true adherence to their self-reported antihypertensives, despite 75.3% (0.6-0.8) reporting adherence. Greatest medication adherence was achieved with angiotensin II receptor blockers (61%), with calcium-channel blockers and mineralocorticoid antagonists demonstrating least adherence (38%).
Conclusion: In patients attending a tertiary hypertension clinic, the combined use of spot urine mass spectrometry and self-reporting identifies higher rates of nonadherence when compared to either modality alone. Both techniques should be combined for more accurate detection of medication adherence.
(© 2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)
Databáze: MEDLINE
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