Key result
Therapeutic plasma levels of amlodipine and suppressed ACE were associated with significantly lower blood pressures (26/20 mmHg and 21/20 mmHg lower, respectively) in hypertensive patients.
Why the study?
Does therapeutic drug monitoring of amlodipine and ACE inhibition identify non-adherence in patients with apparent treatment-resistant hypertension?
Observational (n=100)
Does therapeutic drug monitoring of amlodipine and ACE inhibition identify non-adherence in patients with apparent treatment-resistant hypertension?
Effect estimate: 21/20 mmHg lower (ACE suppressed) and 26/20 mmHg lower (therapeutic amlodipine)
Therapeutic drug monitoring of antihypertensive medications can identify non-adherence and distinguish true from pseudo-resistant hypertension.
Therapeutic drug monitoring may identify non-adherence in resistant hypertension; leaves open outcome impact in prospective trials.
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.
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Jones et al. (2017) conducted an observational in Apparent treatment-resistant hypertension (n=100). Therapeutic plasma levels of amlodipine and suppressed ACE vs. Sub-therapeutic medication levels / unsuppressed ACE was evaluated on Blood pressure differences based on plasma medication levels (21/20 mmHg lower (ACE suppressed) and 26/20 mmHg lower (therapeutic amlodipine)). Therapeutic plasma levels of amlodipine and suppressed ACE were associated with significantly lower blood pressures (26/20 mmHg and 21/20 mmHg lower, respectively) in hypertensive patients.
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