Monitoring antihypertensive drug concentrations to determine nonadherence in hypertensive patients with or without a kidney transplant.

Autor:	Peeters LEJ; Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy.; Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Division of Vascular Medicine., Hesselink DA; Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Division of Nephrology and Transplantation.; Erasmus MC, University Medical Center Rotterdam, Erasmus MC Transplant Institute., Lafeber M; Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Division of Vascular Medicine., Severs D; Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Division of Nephrology and Transplantation.; Erasmus MC, University Medical Center Rotterdam, Erasmus MC Transplant Institute., van den Hoogen MWF; Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Division of Nephrology and Transplantation., Sonneveld MAH; Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Division of Vascular Medicine., Ramakers CRB; Erasmus MC, University Medical Center Rotterdam, Department of Clinical Chemistry, Rotterdam, the Netherlands., Bahmany S; Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy., van Gelder T; Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy.; Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Division of Nephrology and Transplantation.; Erasmus MC, University Medical Center Rotterdam, Erasmus MC Transplant Institute., Koch BCP; Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy., Versmissen J; Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy.; Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Division of Vascular Medicine.
Jazyk:	angličtina
Zdroj:	Journal of hypertension [J Hypertens] 2023 Aug 01; Vol. 41 (8), pp. 1239-1244. Date of Electronic Publication: 2023 May 06.
DOI:	10.1097/HJH.0000000000003459
Abstrakt:	Background: Nonadherence to antihypertensive drugs (AHDs) is a major contributor to pseudo-resistant hypertension. The primary objective of this study was to determine the prevalence of nonadherence to AHDs among patients visiting the nephrology and vascular outpatient clinics. Methods: Patients were eligible to participate in this prospective observational study if they used at least two AHDs that could be measured with a validated UHPLC-MS/MS method and had an office blood pressure at least 140 and/or at least 90 mmHg. For resistant hypertension, included patients had to use at least three AHDs including a diuretic or four AHDs. Adherence was assessed by measuring drug concentrations in blood. The complete absence of drug in blood was defined as nonadherence. A posthoc analysis was performed to determine the influence of a having a kidney transplant on the adherence rates. Results: One hundred and forty-two patients were included of whom 66 patients fulfilled the definition of resistant hypertension. The overall adherence rate to AHDs was 78.2% ( n  = 111 patients), with the highest adherence rate for irbesartan (100%, n  = 9) and lowest adherence rate for bumetanide ( n  = 69%, n  = 13). In further analysis, only kidney transplantation could be identified as an important factor for adherence (adjusted odds ratio = 3.35; 95% confidence interval 1.23-9.09). A posthoc analysis showed that patients with a kidney transplant were more likely to be adherent to AHDs (non-KT cohort 64.0% vs. KT-cohort 85.7%, χ 2 (2) = 10.34, P  = 0.006). Conclusion: The adherence rate to AHDs in hypertensive patients was high (78.2%) and even higher after a kidney transplant (85.7%). Furthermore, patients after kidney transplant had a lower risk of being nonadherent to AHDs. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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