Hypertension: Screening For Medication Non-Adherence Critical Before Renal Denervation

MedicalResearch.com Interview with:

Dr Prashanth Patel MSc, FRCP, FRCPath Consultant Metabolic Physician/ Chemical Pathologist and Head of Service Department of Chemical Pathology and Metabolic Diseases Honorary Senior Lecturer, Dept of Cardiovascular Sciences University of Leicester

Dr. Patel Prashanth

Dr Prashanth Patel MSc, FRCP, FRCPath
Consultant Metabolic Physician/ Chemical Pathologist and Head of Service
Department of Chemical Pathology and Metabolic Diseases
Honorary Senior Lecturer
Dept of Cardiovascular Sciences
University of Leicester

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

Dr. Patel: Hypertension (HTN) is one of the most important and common chronic treatable condition. It affects nearly one third of the adult population. Nearly one fifth of patients treated for hypertension are thought to be resistant to treatment and these patients have a high mortality from cardiovascular diseases. Percutaneous radiofrequency catheter-based renal sympathetic denervation (renal denervation, RD) may be a potential treatment for resistant hypertension. Although RD is a safe procedure, it is irreversible and expensive. It is important that patients’ suitability for renal denervation is carefully assessed to maximise the potential benefits of the procedure. Therefore causes of pseudo-resistant hypertension namely white-coat hypertension, suboptimal pharmacological antihypertensive treatment and non-adherence to antihypertensive medications and secondary hypertension are needed to be robustly ruled out before considering a patient as suitable for renal denervation.

MedicalResearch.com: What are the main findings?

Dr. Patel: In this study we utilised this assay in a diagnostic pathway to assess the suitability of patients referred for renal denervation at our Hypertension Centre (n=34). 2

We found around 23.5% of patients referred for renal denervation were non-adherent to antihypertensive treatment by using this novel test. We also found that around 52.9% percentage of patients had pseudo-resistance hypertension and early exclusion of these cases collectively in a diagnostic pathway reduces the eligibility for intervention by renal denervation.

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

Dr. Patel: Our single centre study showed that majority of the patients referred for renal denervation have pseudo-resistant hypertension and hence are not suitable for RD. Non-adherence to antihypertensive medication is the most common form of pseudo-resistant hypertension. Adherence to antihypertensive medications can be easily tested by a simple, non-invasive and inexpensive test of HPLC-MS/MS in urine. We recommend that biochemical adherence is performed early in the evaluation pathway to assess the suitability of patients for renal denervation.

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

Dr. Patel:: It is important that other centres replicate our findings. Further a cost benefit analysis would be useful to help improve efficiencies and avoid unnecessary investigations. Finally we recommend that in research related to resistant hypertension, it is important that non-adherence is excluded by an objective biochemical measure.

References:
1. Tomaszewski M, White C, Patel P et al. High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry urine analysis. HEART 2014; 100: 855-61

2. Patel P, Gupta P, White C, Stanley A, Williams B and Tomaszewski M. Screening for non-adherence to antihypertensive treatment as a part of the diagnostic pathway to renal denervation. JHH 2015. doi:10.1038

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

Citation:

J Hum Hypertens. 2016 Jun;30(6):368-73. doi: 10.1038/jhh.2015.103. Epub 2015 Oct 8.
Screening for non-adherence to antihypertensive treatment as a part of the diagnostic pathway to renal denervation.

Patel P1,2,3, Gupta PK1,2,3, White CM2,4, Stanley AG4, Williams B5,6, Tomaszewski M2,3,4.

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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