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February 24, 2022British Journal of Clinical PharmacologyOpen Access

Major disparities in patient‐reported adherence compared to objective assessment of adherence using mass spectrometry: A prospective study in a tertiary‐referral hypertension clinic

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Why the study?

Determining true rates of antihypertensive adherence in clinic settings is challenging, prompting a comparison of patient-reported adherence with objective mass spectrometry spot urinalysis.

Does objective assessment using mass spectrometry spot urinalysis identify different rates of antihypertensive medication adherence compared to patient self-reporting in treatment-resistant hypertension?

Population

73 patients with apparent treatment-resistant hypertension or suspected secondary causes in a tertiary referral clinic

Comparison

Patient-reported adherence vs objective mass spectrometry spot urinalysis

Design

Prospective observational single-centre cohort study

Key result

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.

Authors

JCJames CurneenLRLouise RabbittDBDarragh Browne

Discussion

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Overview

Self-reported adherence substantially overestimates true rates; leaves open whether routine objective testing improves resistant hypertension management.

Key Points

  • To compare patient-reported antihypertensive adherence with objective adherence verified by mass spectrometry spot urinalysis in a tertiary referral hypertension clinic.
  • Conducted a prospective observational single-centre cohort study in a tertiary referral hypertension clinic among patients referred for apparent treatment-resistant hypertension or suspected secondary causes (N=105 recruited, N=73 analyzed).
  • Evaluated participant self-reported medication adherence alongside objective spot urine testing for prescribed antihypertensive medications and metabolites using high-performance liquid chromatography tandem mass spectrometry.
  • True adherence confirmed by both self-reporting and objective mass spectrometry was observed in 27.4% (95% CI 0.2–0.4) of participants, despite 75.3% (95% CI 0.6–0.8) self-reporting adherence.
  • Adherence rates varied by drug class, with the highest adherence seen in angiotensin II receptor blockers (61%) and the lowest adherence seen in calcium-channel blockers and mineralocorticoid antagonists (38%).

Study Design

Type

Cohort (n=73)

Multicenter

No

Structured PICO

Does objective assessment using mass spectrometry spot urinalysis identify different rates of antihypertensive medication adherence compared to patient self-reporting in treatment-resistant hypertension?

P
Population
73 patients referred to a tertiary hypertension clinic with apparent treatment-resistant hypertension or suspected secondary causes.
I
Intervention
Objective assessment of antihypertensive adherence using high-performance liquid chromatography tandem mass spectrometry spot urinalysis combined with self-reporting.
C
Comparator
Patient self-reported assessment of antihypertensive adherence alone.
O
Outcome
True adherence to antihypertensive medications (defined as demonstrating both self-reported adherence and objective mass spectrometry evidence).surrogate

Main Result

Absolute Event Rate: 27.4% vs 75.3%

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.

Cite This Study

Curneen et al. (2022) 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.

synapsesocial.com/papers/6a17f006a0e670aec86ee618https://doi.org/10.1111/bcp.15292
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