PP.05.12] DRUG NON-ADHERENCE AS MAJOR CAUSE OF SEVERE HYPERTENSION AT THE EMERGENCY DEPARTMENT

Abstract

Objective: Severe hypertension is frequently encountered in the emergency department (ED). To distinguish hypertensive urgency (HU) from hypertensive emergency (HE) is essential, as in HE rapid blood pressure (BP) lowering is paramount to prevent progressive organ damage. Medication non-adherence is considered to be an important risk factor for developing HE or HU, but exact numbers are lacking. The objectives of our study were (1) to retrospectively examine the incidence of HU and HE and to identify characteristics aiding in the differentiation between HU and HE and (2) to prospectively assess the incidence of medication non-adherence in severe hypertension. Design and method: We (1) retrospectively analyzed patients with systolic blood pressure (SBP) of 180 mmHg or higher and diastolic blood pressure (DBP) 110 mmHg or higher who presented at our ED in 2012–2015 and performed (2) a prospective study in patients presenting at the ED with SBP 180 mmHg or higher or DBP 120 mmHg or higher from September to December 2016, in whom we measured plasma drug levels of prescribed antihypertensive drugs. Results: We included 1126 patients in the retrospective analysis. In preliminary analyses of 700 patients, 255 (36,4%) patients met the criteria for HE and 147 (21%) for HU. Mean SBP (SD) was 203 mmHg (±18.1) and mean DBP 121 mmHg (±12). Mean age was 58 (±18) years; 54.5% were male. Of 352 patients who were previously prescribed antihypertensive drugs, 193 patients had 2 or more antihypertensive drugs. In the preliminary analysis of 22 patients of the prospective study, 6 patients were non-adherent for at least one of the prescribed antihypertensive drugs, whereas 4 patients were completely non-adherent for multiple antihypertensive drugs. Conclusions: Of all patients previously prescribed antihypertensive drugs, almost one third appeared non-adherent for at least one drug. Combining these results with the results of our retrospective study, where 28% of patients had already been prescribed two or more different antihypertensive drugs, the role of non-adherence in the etiology of HU or HE at the ED is considerably, pressing the importance to improve drug adherence to save costs and disease burden.