Key result
Amlodipine-based therapy leaves ~44% of hypertensive patients above ESC target blood pressure.
Why the study?
Evaluating adherence via target blood pressure across age groups and developing a rapid clinical method to determine amlodipine and its metabolite were needed.
Does ongoing amlodipine-based therapy achieve ESC guideline target blood pressures in real-world hypertensive patients?
Observational (n=81)
No
Does ongoing amlodipine-based therapy achieve ESC guideline target blood pressures in real-world hypertensive patients?
A significant proportion of hypertensive patients remain uncontrolled despite utilizing fixed-dose combinations, highlighting the need for therapeutic drug monitoring and educational interventions.
Many patients miss ESC BP targets on amlodipine despite fixed-dose combos; leaves open whether monitoring or interventions improve real-world control.
Background and Objectives: Blood pressure measurement is essential evidence to establish that the chosen medicine and dosage are appropriate, and also indirectly indicates whether the medicine is being used at all. Therefore, current research compares adherence to the target blood pressure at home and in the hospital between different age groups, using similar combinations of the drugs prescribed by the doctor within ongoing antihypertensive therapy. Moreover, it is very important to develop a method for the determination of amlodipine and its metabolite, which would suitable for clinical applications, when the result is needed as quick as possible. Materials and Methods: This prospective study included patients aged ≥18 years who were diagnosed with hypertension. Subjects were divided into two age groups according to European Society of Cardiology (ESC) hypertension guidelines; older patients (≥65 years) and adult patients (<65 years). Assessment of adherence rate to antihypertensive medications was performed using a measurement of systolic blood pressure and comparing this to ESC hypertension guideline data. A simple liquid chromatography-tandem mass spectrometer (LC-MS/MS) method for determination of amlodipine and dehydroamlodipine was developed and validated according to the European Medicines Agency guideline on bioanalytical method validation at the Latvian Institute of Organic Synthesis. Results: A total of 81 patients with arterial hypertension were enrolled in this study. A significant number of patients were overweight (N = 33, 40.7%) and obese (N = 36, 44.4%). To control arterial hypertension, 70 (86.4%) patients used fixed-dose combinations, where one of the components was amlodipine. Practically, 36 (44.4%) hypertensive subjects were not able to comply with target blood pressure. Nonetheless, 38 (46.9%) patients who received fixed-dose combinations were able to comply with target blood pressure. Conclusions: Adherence to ESC hypertension guideline proposed target blood pressure was relatively low among hypertensive subjects even though a significant number of patients were taking fixed-dose combinations. Therefore, optimizing prevention, recognition, and care of hypertensive young adults require intensive educational interventions. Moreover, survey data suggest that therapeutic drug monitoring using the validated simple, sensitive LC-MS/MS method is pivotal for further understanding factors influencing adherence.
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Kustovs et al. (2023) conducted an observational in Arterial hypertension (n=81). Amlodipine-based antihypertensive therapy was evaluated on Failure to comply with ESC hypertension guideline target blood pressure. Amlodipine-based therapy resulted in 44.4% of patients failing to reach ESC guideline target blood pressures despite widespread use of fixed-dose combinations.
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