IMPLEMENTATION OF URINARY DRUG DETECTION FOR ASSESSMENT OF ADHERENCE TO ANTIHYPERTENSIVE DRUGS IN DAY-TO-DAY CARE IN A TERTIARY HYPERTENSION CLINIC IN PARIS AREA

Abstract

Objective: Non-adherence to antihypertensive drug (AHD) therapy is a major health challenge contributing to uncontrolled/resistant hypertension and major adverse cardiovascular events. We report here the results of implementation of AHD screening in spot urine samples in day-to-day care of patients with severe resistant hypertension (RHTN) in a tertiary hypertension clinic of Paris area. Design and method: Urine AHD screening was performed using ultrahigh performance LC-MS/MS in patients with apparent RHTN (office BP>140/90 mmHg despite 3 AHD including a diuretic) when poor adherence was clinically suspected. Full adherence (FA) was defined as the presence of all prescribed AHD, and partial adherence (PA) or complete nonadherence (NA) as the absence of at least one or all prescribed AHD, respectively. Results: We included 119 patients with RHTN (53.8% men), aged 54.9 years, with office SBP/DBP of 168/96 mmHg despite prescription of a median of 4.0 AHD. There were 58 (48.7%) FA patients, 41 (34.5%) PA patients, and 20 (16.8%) NA patients. In decreasing order of prescription, we detected ARB/ACEI in 60.4% of the patients (n = 58/96), CCB in 55.4% (n = 46/80), thiazides in 50.0% (n = 40/80), alpha-blockers in 66.7% (n = 34/51), beta-blockers in 72.9% (n = 35/48), spironolactone in 51.1% (n = 23/45), centrally acting AHD in 78.0% (32/41), furosemide in 76.2% (16/21) and amiloride in 81.8% of the patients (n = 9/11). Poor adherence (PA+NA, n = 61) was associated with younger age (53 vs. 58 yrs, p = 0.09), female sex (54% vs. 38%, p = 0.08), higher SBP/DBP (174/102 vs. 162/90mmHg, p = 0.001/0.02), higher eGFR (79 vs. 66 ml/min, p = 0.02), more AHD (5 vs. 4, p < 0.001) but not to less single pill combination prescription (66% vs. 57%, ns) compared to full adherence. Conclusions: Urine AHD screening allows to detect that < 50% of the patient with RHTN are FA and 16.8% are completely NA. The AHD recommended by the ESH guidelines for RHTN (ACEI/ARB, thiazides, CCB and spironolactone) were only detected in 50 to 60% of the patients which explains the persistence of uncontrolled severe hypertension. However, in FA patients, BP remained high suggesting inadequate use of AHD by physicians or white coat adherence by patients.