Key result
Serum drug concentration measurements detected a 7.3% prevalence of nonadherence in hypertensive patients on ≥2 agents, revealing poor overlap with indirect assessment methods.
Why the study?
Nonadherence to drugs is a major challenge in hypertension treatment, prompting the need to assess its prevalence using serum drug concentrations versus indirect methods and relate it to prescribed regimens.
Does measurement of serum drug concentrations improve detection of nonadherence compared to indirect methods in patients with hypertension using ≥2 antihypertensive agents?
Observational (n=550)
Yes
Does measurement of serum drug concentrations improve detection of nonadherence compared to indirect methods in patients with hypertension using ≥2 antihypertensive agents?
Serum drug concentration measurements objectively detect nonadherence to antihypertensive therapy, revealing higher diastolic blood pressures and pill burdens in nonadherent patients compared to indirect assessment methods.
Answers are grounded in this paper and cite their sources.
Serum concentrations may detect nonadherence missed by indirect methods; leaves open whether routine testing improves hypertension outcomes.
Nonadherence to drugs is a challenge in hypertension treatment. We aimed to assess the prevalence of nonadherence by serum drug concentrations compared with 2 indirect methods and relate to the prescribed drug regimens in a nationwide multicenter study. Five hundred fifty patients with hypertension using ≥2 antihypertensive agents participated. We measured concentrations of 23 antihypertensive drugs using ultra high performance liquid chromatography tandem mass-spectrometry and compared with patients’ self-reports and investigators’ assessment based on structured interview. We identified 40 nonadherent patients (7.3%) using serum drug concentrations. They had higher office diastolic blood pressure (90 versus 83 mm Hg, P <0.01) and daytime diastolic blood pressure (85 versus 80 mm Hg, P <0.01) though systolic blood pressures did not differ significantly. They had more prescribed daily antihypertensive pills (2.5 versus 2.1 pills, P <0.01) and total daily pills (5.5 versus 4.4 pills, P =0.03). Prescription of fixed-dose combination pills were lower among the nonadherent patients identified by serum concentrations (45.0 versus 67.1%, P <0.01). Fifty-three patients self-reported nonadherence, while the investigators suspected 69 nonadherent patients. These groups showed no or few differences in drug regimens, respectively. In summary, we detected 7.3% prevalence of nonadherence by serum drug measurements in patients using ≥2 antihypertensive agents in a nationwide study; they had higher office and ambulatory diastolic blood pressures, higher number of prescribed daily pills, more daily antihypertensive pills, and less frequent prescriptions of fixed-dose combination pills. Indirect methods showed poor overlap with serum drugs concentrations and no or minimal medication differences. Thus, serum measurements of drugs were useful in detection and characterization of nonadherence to antihypertensive treatment. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03209154.
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Bergland et al. (2021) conducted an observational in Hypertension (n=550). Serum drug concentration measurement vs. Indirect methods (self-report and investigator assessment) was evaluated on Prevalence of nonadherence. Serum drug concentration measurements detected a 7.3% prevalence of nonadherence in hypertensive patients on ≥2 agents, revealing poor overlap with indirect assessment methods.
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