Therapeutic drug monitoring of amlodipine and the Z-FHL/HHL ratio: Adherence tools in patients referred for apparent treatment-resistant hypertension
| Autor: | Sandra Castel, Sylva L. U. Schwager, Erika Jones, Eric H Decloedt, Marc Blockman, Edward D. Sturrock, Maia Lesosky, Lubbe Wiesner, Brian Rayner |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
ACE inhibitors Urology lcsh:Medicine Therapeutic drug monitoring 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine 050602 political science & public administration medicine In patient Enalapril Amlodipine Ace inhibition Treatment resistant lcsh:R5-920 medicine.diagnostic_test Hypotensive agents business.industry lcsh:R 05 social sciences General Medicine Plasma levels 0506 political science Endocrinology Adherence Hypertension lcsh:Medicine (General) business Antihypertensives medicine.drug |
| Zdroj: | SAMJ: South African Medical Journal, Volume: 107, Issue: 10, Pages: 887-891, Published: OCT 2017 South African Medical Journal; Vol 107, No 10 (2017) South African Medical Journal, Vol 107, Iss 10, Pp 887-891 (2017) |
| ISSN: | 2078-5135 |
| Popis: | Background. Non-adherence to antihypertensives is a cause of ‘pseudo-treatment-resistant’ hypertension. Objective. To determine whether monitoring plasma amlodipine concentrations and inhibition of angiotensin-converting enzyme (ACE) can be adjunct adherence tools. Methods. Patients with hypertension who were prescribed enalapril and amlodipine were enrolled. Blood pressures (BPs) were monitored and an adherence questionnaire was completed. Steady-state amlodipine was assayed using liquid chromatography-mass spectrometry and degree of ACE inhibition using the Z-FHL/HHL (z-phenylalanine-histidine-leucine/hippuryl-histidine-leucine) ratio. Results. One hundred patients (mean (standard deviation) age 50.5 (12) years, 46% male) were enrolled. Based on plasma assays, 26/97 patients (26.8%) were unsuppressed by enalapril and 20/100 (20%) were sub-therapeutic for amlodipine. There were significant BP differences based on plasma levels of the medication: 21/20 mmHg lower in the group with suppressed ACE and 26/20 mmHg in the group with steady-state amlodipine concentrations. Conclusions. Monitoring antihypertensive adherence by assaying plasma medication concentrations is a feasible option for evaluating true v. pseudo-resistant hypertension.S Afr Med J 2017;107(10):887-891 |
| Databáze: | OpenAIRE |
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