Abstract 115: An Action Plan To Improve Biochemically Detected Non-adherence To Antihypertensive Treatment Results In A Short-term Reduction In Arterial Stiffness And A Long-term Reduction In Albuminuria (the ATHAN Clinical Trial)

Abstract

We previously shown that a specific 3-months(m) intervention improved therapeutic adherence in patients with non-controlled hypertension (HT) decreases blood pressure (BP). We aim to evaluate if there is also a decrease in HT-mediated organ damage (HMOD) at short- and long-term. We conducted a prospective, randomized clinical trial in a HT Unit. Consecutively attended patients with 24h-BP >or=130/80 mmHg despite receiving at least 2 antihypertensive drugs and with therapeutic non-adherence confirmed by determination of antihypertensives in urine (n=47) were randomized (1:1) to receive a specific 3m program to improve adherence (INT=intervention) or routine follow-up (C=control). Antihypertensive treatment was not changed. Prior to randomization, and at 3m and 12m, the presence of antihypertensives in urine and albuminuria were determined. BP and pulse wave velocity (PWV) were evaluated by 24h- ambulatory monitoring in all periods. After 3m, all patients received usual care. At 3m, the adjusted BP differences (mean; 95% CI) from baseline (INT vs. C) were -14.3 mmHg (-5.1 to -23.5), p=0.003, and -10, 0 mmHg (-4.0 to -16.0), p=0.002, for 24h-SBP and 24h-DBP, respectively. The INT group maintained the decrease in BP at 12m. vs baseline: mean change (95% CI) of 24h-SBP = -16.1 mmHg (-22.8 to -9.4), p <0.001 and 24h-DBP change = -7.8 (-12, 8 to -2.7), p=0.002. In the INT group, the percentage of undetected antihypertensive drugs decreased from baseline (median [interquartile range]): 40% [20-100], 0% [0-25], and 18.3% [0-40] at baseline, 3m and 12m, respectively; Z= -3.426 (p<0.001) and Z= -3.055 (p=0.002) for changes at 3m and 12m, respectively. PWV decreased at 3m only in the INT group: mean difference (95% CI) -0.402 m/sec (-0.054 to -0.749), p=0.025, but not at 12m. Albuminuria (median [IQR]) decreased in the INT group at 12m: 27.1 mg/g [11.1-116.2] and 22.4 mg/g [6.4-91.9] at baseline and 12 m, respectively (Z=-2.207, p=0.027). In conclusion, urine biochemical detection of therapeutic non-adherence and a specific 3m-intervention to improve adherence lead to better BP control, which maintains in the long term. In addition, there is a decrease in arterial stiffness in the short term and a regression of albuminuria in the long term, thus reducing the HMOD.