Abstract P367: Adherence Assessment Via Comprehensive Identification and Quantitation of Circulating Medications with Significant Correlation to Lower Blood Pressure Observed in Hypertensive Patients

Abstract

Employing a novel and proprietary comprehensive precision medicine clinical tool that is a LC/MS/MS-based platform (PrecisCMQ™), we analyzed the serum of HTN patients seeking emergency care (n=293) for the presence and quantity of 42 antihypertensive and cardiovascular medications. Patient self-reported adherence correlated with clinical tool-based adherence. Among patients prescribed > 3 medications, clinical tool-based adherence in patients (n=74) who indicate they never miss a dose was 74%, versus 60% in patients (n=69) who reported missed doses (p = 0.009, two-sided t-test; median prescribed medications = 3.5). Patients were considered adherent when 80% of prescribed medications were detected and categorized as nonadherent otherwise. Among patients with > 3 prescribed medications, we found adherent patients had lower SBP (9.7 mm Hg; 95% CI 1.8 - 17.6; p = 0.02) and lower DBP (6.9 mm Hg; 95% CI 1.9 - 12.1; p = 0.007) after adjusting for age, sex, BMI, and patient-reported adherence. No significant difference in BP was observed in patients prescribed < 3 medications. By comparing medication clinical tool-based detections to prescribed medications listed in the EHR, 12% of the detected medications (68/549) were not recorded in the patients’ EHR. After accounting for the above covariates and the number of medications in the EHR, we observed that the total number of detected medications, including prescriptions not in the EHR, significantly correlated with both SBP (attributed to 4.8% of variation; p = 0.01) and DBP (patients prescribed > 3medications; explaining 2.5% of BP variation; p = 0.05). Additionally, to assess whether patients with higher systemic medication concentrations had lower BP, we compared SBP and DBP to medication concentrations normalized to published reference ranges. After accounting for the above covariates and the number of detected medications, we observed a relationship between medication(s) concentration(s) and BP across all patients. Together, these results support the utility of clinical tool-based medication monitoring for assessing adherence and improving BP control in HTN patients.