Medication non-adherence identified via unannounced plasma drug monitoring was present in 79% of patients and associated with significantly higher systolic blood pressure (189.0 vs 174.5 mmHg; p<0.05).
Observational (n=24)
No
Does unannounced plasma drug monitoring reveal medication non-adherence in patients with difficult-to-control blood pressure?
Unannounced plasma drug monitoring in patients with suspected resistant hypertension reveals high rates of non-adherence, which correlates with higher blood pressure and greater treatment burden.
Absolute Event Rate: 189% vs 174.5%
p-value: p=<0.05
Objective: Medication non-adherence is a major barrier to blood pressure (BP) control. While indirect methods like questionnary often overestimate adherence, unannounced plasma drug monitoring (PDM) provides an objective 'snapshot’ of patient behavior. We aimed to assess the real-world value of unannounced PDM in patients with difficult-to-control blood pressure.Design and method: We devopped a simple, rapid and sensitive quantification method for 21 anti-hypertensive or diuretic drugs in plasma for clinical applications using liquid chromatography with tandem mass spectrometry (LC-MS/MS). We conducted a retrospective study of our first 24 patients who underwent unannounced PDM immediately following a specialized hypertension consultation at Grenoble University Hospital. Patients were categorized into three groups based on PDM results: Observant (100% of prescribed drugs detected), Non-Observant (0% detected), and Partially Observant (some drugs detected). Statistical analysis was performed using Kruskal–Wallis test and Fisher's exact test. Results: The PDM revealed that only 21% (n=5) of patients were fully observant, while 46% (n=11) were partially observant and 33% (n=8) were totally non-compliant. BP Levels at the consultation: Systolic Blood Pressure (SBP) was significantly higher in the Non-Observant group (189.0 ± 19.4 mmHg) compared to the Observant group (174.5 ± 17.3 mmHg) (p < 0.05). Treatment Burden: There was a clear correlation between the complexity of the regimen and non-adherence. Observant patients had significantly fewer prescribed treatments (2.4 ± 1.2) compared to Non-Observant (4.5 ± 2.1) and Partially Observant (3.7 ± 1.3) patients (p < 0.05). Demographics: Non-adherence was more frequent in women (73.6% of the non/partially observant groups) and older patients (Mean age 53.0 in Non-Observants vs 41.0 in Observants). Conclusions: In patients referred in Specialized Hypertension Consultation for suspected resistant hypertension, unannounced plasma antihypertensive drug measurements revealed a high prevalence of pseudo-resistance due to poor adherence, often involving multiple missing treatments. This strategy provides valuable objective information to avoid futile treatment escalation and may significantly impact clinical decision-making and patient management
Boudin et al. (Fri,) conducted a observational in Difficult-to-control blood pressure (n=24). Medication non-adherence (identified via unannounced plasma drug monitoring) vs. Full adherence (Observant) was evaluated on Systolic Blood Pressure (SBP) (p=<0.05). Medication non-adherence identified via unannounced plasma drug monitoring was present in 79% of patients and associated with significantly higher systolic blood pressure (189.0 vs 174.5 mmHg; p<0.05).