Objective assessment using mass spectrometry revealed that only 27.4% of patients demonstrated true adherence to antihypertensives, compared to 75.3% who self-reported adherence.
Cohort (n=73)
No
Does objective assessment using mass spectrometry spot urinalysis identify different rates of antihypertensive medication adherence compared to patient self-reporting in treatment-resistant hypertension?
Objective mass spectrometry urinalysis reveals that true adherence to antihypertensive medications is drastically lower than patient self-reporting suggests in patients with apparent treatment-resistant hypertension.
Absolute Event Rate: 27.4% vs 75.3%
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.
Curneen et al. (Thu,) conducted a cohort in Apparent treatment-resistant hypertension or suspected secondary causes (n=73). Mass spectrometry spot urinalysis vs. Self-reported assessment was evaluated on Adherence to antihypertensive medications. Objective assessment using mass spectrometry revealed that only 27.4% of patients demonstrated true adherence to antihypertensives, compared to 75.3% who self-reported adherence.