Risk Factors for Nonadherence to Antihypertensive Treatment

MedicalResearch.com Interview with:

Dr. Gupta Pankaj


Dr. Gupta Pankaj
Consultant Metabolic Physician/Chemical Pathologist

Dr. Patel Prashanth - Consultant Metabolic Physician/Chemical Pathologis

Dr. Patel

Dr. Patel Prashanth – Consultant Metabolic Physician/Chemical Pathologist

Department of Metabolic Medicine and Chemical Pathology
University Hospitals of Leicester NHS Trust, UK


MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Non-adherence or patients not taking their medications as prescribed is known since the time of Hippocrates. It is the key reason why blood pressure is well controlled in only around 50% of patients with hypertension, despite the availability of good medicines. Non-adherence leads to poorer cardiovascular outcomes and is thought to cost $100 billion to the US health economy. A crucial reason for the lack of progress in improving adherence has been the previous lack of a clinically useful objective measure.

We and others have developed a robust and reliable biochemical screening method to assess for non- adherence to antihypertensive medications in urine or blood using a technique called liquid chromatography-tandem mass spectrometry.  We have previously reported a single centre study that demonstrated high rates of non-adherence in patients attending a hypertension clinic.

Since, then we have set up a National Centre for Adherence Testing (NCAT, [email protected]) in the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust (UHL) and receive samples from around 25 hypertension clinics across UK. This study analysed data from~1400 patients consisting of samples received in UHL and also from a cohort of patients in the Czech Republic.

MedicalResearch.com: What should readers take away from your report?

Response: More than 40% of the UK cohort and 30% of the Czech cohort were non-adherent to their anti-hypertensive medications. Moreover 14.5% of the UK and 12% of the Czech cohort were not taking any medications. Crucially non-adherence was related to the number of prescribed medications with the risk increasing by >75% with each increase in medication and it was highest with diuretics. The other risk factors for increased non-adherence were younger age and female sex.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: It would be interesting to ascertain whether non-adherent patients, on follow up, improved their medication taking behaviour and if adherence testing led to an improvement in blood pressure. Further, biochemical assessment of non-adherence only provides a snapshot of the adherence status and longer term outcome studies are required.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.


Risk Factors for Nonadherence to Antihypertensive Treatment
Pankaj Gupta, Prashanth Patel, Branislav Štrauch, Florence Y. Lai, Artur Akbarov, Věra Marešová, Christobelle M.J. White, Ondřej Petrák, Gaurav S. Gulsin, Veena Patel, Ján Rosa, Richard Cole, Tomáš Zelinka, Robert Holaj, Angela Kinnell, Paul R. Smith, John R. Thompson, Iain Squire, Jiří Widimský, Nilesh J. Samani, Bryan Williams, Maciej Tomaszewski

Hypertension. 2017;HYPERTENSIONAHA.116.08729
Originally published May 1, 2017

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Last Updated on May 15, 2017 by Marie Benz MD FAAD