LONG-TERM ADHERENCE TO ANTIHYPERTENSIVE TREATMENT BY URINARY/PLASMA DETECTION IN PATIENTS WITH RESISTANT HYPERTENSION IN THE RENAL DENERVATION FOR HYPERTENSION (DENERHTN) TRIAL

Abstract

Objective: The DENERHTN trial reported the BP–lowering efficacy of renal denervation (RD) in addition to a standardized stepped-care antihypertensive treatment (SSAHT) in patients with resistant hypertension (RHTN) vs. SSAHT alone at 6 months despite a similar (around 50%) prevalence of partial+complete nonadherence (NA) to antihypertensive drugs (AHD). We report here adherence to AHD at 12 months. Design and method: 106 patients with RHTN to indapamide 1.5 mg/d, ramipril 10 mg/d (or irbesartan 300 mg/d), and amlodipine 10 mg/d were randomly assigned to RD+SSAHT or SSAHT alone. For SSAHT, spironolactone 25 mg/d, bisoprolol 10 mg/d, prazosin 5 mg/d, and rilmenidine 1 mg/d were sequentially added from 2 to 5 months if home BP was greater than or equal to 135/85 mmHg. From 6 to 12 months, patients received AHD at physician's discretion. At 6 and 12 months, urine/plasma AHD screening with ultrahigh performance LC-MS/MS was performed on available samples. Results: From 6 to 12 months, 25/44 (56.8%) RD+SSAHT patients and 26/53 (49.1%) SSAHT patients had a change in their antihypertensive treatment by their physician (p = 0.446). The percentage of NA decreased between 6 and 12 months from 50.0% (n = 20/40) to 42.9% (n = 15/35) in the RD+SSAHT group and from 53.3% (n = 24/45; p = 0.759) to 41.7% (n = 15/36; p = 0.919) in the SSAHT group. Among patients with samples at both 6 and 12 months, 10/33 (30.3%) RD+SSAHT patients and 7/33 (21.2%) SSAHT patients had a change in adherence (p = 0.398). A total of 5/18 (27.7%) RD+SSAHT and 0/13 (0/0%) SSAHT patients who were adherent at 6 months became NA at 12 months (p = 0.0580). Conversely, the same proportion of patients who were NA at 6 months became adherent at 12 (RD+SSAHT: n = 5/15, 33.3% vs. SSAHT: n = 7/20, 35%). Conclusions: In patients with RHTN of the DENERHTN trial, the prevalence of NA to AHD drugs at 12 months remained high >40% but not different in the RD+SSAHT and SSAHT groups. About 1/3 of the patients became adherent at 12 months in both groups. However, numerically more patients became NA in the RD+SSAHT group than in the SSAHT group, which may impact the BP response to RD.