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, ncat@uhl-tr.nhs.uk) 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

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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One thought on “Risk Factors for Nonadherence to Antihypertensive Treatment

  1. Larionov BV The sodium content in the urine at different arterial pressures. Kazan State Medical University. In the deposited monograph B.V. Larionov, 1984 [1], indicated the increase in sodium content in blood plasma and urine in hypertensive disease – GB. All the following references can be found [2]. An increase in the concentration of sodium entails edema of the vascular wall with a decrease in the internal diameter of the vessel. According to other data, with GB, the small vessels of the goiter also decrease in one way or another. The sodium intake, the mean body weight and the average urinary sodium excretion were unchanged in the control group and significantly decreased with sodium restriction. A significant correlation (rs = 0.70, p less than 0.05) is shown between the decrease in sodium in daily urine and the change in mean BP. With a low salt diet, the excretion of salt with urine was significantly lower, and in the case of high salt water it was significantly higher than in the control period. Sodium in the body accumulates with its excessive consumption. With physical exertion, sweating intensifies, and since sweat contains up to 0.6-0.8% NaCl or more, sodium is vigorously excreted from the body; In this regard, and lowering blood pressure. With physical exertion, urinary excretion also increases, and sodium is also excreted in the urine. When transferred to a low-sodium, hypocaloric, low-cholesterol diet, the diastolic pressure decreased over 3 years from 122 mm Hg to 91-93, and the sodium content in the urine in meq / 24 hours decreased from 224 to 47. Work requires repeated and verified by independent researchers, for such Programs need the allocation of grants. Why check? Because the work converges with others to reduce consumption and excretion of Na, but diverges in time of lowering blood pressure with other studies; According to which the decrease in blood pressure begins already from 3-14 days of low-fat diet. When translating 15 women and 16 men into a diet with a low sodium content, the women in the control period had 130.2 + _8.47 mEq sodium per day, with a low diet – 59.69 + _5.65, i.e. 2 times lower; In men in the control period – 175.03 + _17.07, and on a diet with a low sodium content – 78.74 + _6.18 is also 2 times lower. We have developed a single standard or standard for sodium in the urine with normal blood pressure – 1.4-4 g / l, on average – 3.25 + _0.36 g / l: with a normal blood pressure from 120/80 to 139/89 – 5.33 + _0.85 G / l. A lot of data accumulated, that with a decrease in the intake of salt under counter-sodium in the urine, blood pressure decreases at any stage of GB. With age, the sodium content in daily urine increases – at 30 years – 1176 people – 154 + _7 mmol per day, in 30-45 years – 1157 people – 161 + _65, 45 years – 1030 people – 171 + _64. If the case was only at the age, then all the elderly would be ill with GB, but not all are ill, because not all overeat salt in such excess quantities. For hypertensive patients and hypotensive patients, a routine direction is necessary to analyze the sodium content in a single or daily urine sample, for patients with hyperacidosis, the direction for the chloride content in the urine. It is desirable to study sodium in the urine of long-livers. 1. Larionov B.V Biogeochemical sodium theory of etiology, prevention and geographical spread of hypertonic and hypotonic diseases. D-8582, p. 1-89. Kazan. 1984. 2. Larionov B.V. How can I extend my life? How to reduce mortality in Russia? .. Publishing House: 2014. Lap Lambert Academic Publishing. 612 pages. Published: Trends in the development of science and education. Sat. Scientific papers. International Scientific and Practical Conference on July 31, 2016. Part 1. Smolensk, 2016, p. 17-19.

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