We hypothesized that screening for nonadherence to antihypertensive treatment using liquid chromatography-tandem mass spectrometry-based biochemical analysis of urine/serum has therapeutic applications in nonadherent hypertensive patients. A retrospective analysis of hypertensive patients attending specialist tertiary care centers was conducted in 2 European countries (United Kingdom and Czech Republic). Nonadherence to antihypertensive treatment was diagnosed using biochemical analysis of urine (United Kingdom) or serum (Czech Republic). These results were subsequently discussed with each patient, and data on follow-up clinic blood pressure (BP) measurements were collected from clinical files. Of 238 UK patients who underwent biochemical urine analysis, 73 were nonadherent to antihypertensive treatment. Their initial urinary adherence ratio (the ratio of detected to prescribed antihypertensive medications) increased from 0.33 (0-0.67) to 1 (0.67-1) between the first and the last clinic appointments. The observed increase in the urinary adherence ratio in initially nonadherent UK patients was associated with the improved BP control; by the last clinic appointment, systolic and diastolic BPs were ≈19.5 and 7.5 mm Hg lower than at baseline (P=0.001 and 0.009, respectively). These findings were further corroborated in 93 nonadherent hypertensive patients from Czech Republic-their average systolic and diastolic BPs dropped by ≈32.6 and 17.4 mm Hg, respectively (P<0.001), on appointments after the biochemical analysis. Our data show that nonadherent hypertensive patients respond to liquid chromatography-tandem mass spectrometry-based biochemical analysis with improved adherence and significant BP drop. Such repeated biochemical analyses should be considered as a therapeutic approach in nonadherent hypertensive patients.

• Keywords
• adherence, antihypertensive agents, blood pressure, chromatography, liquid, hypertension,
• MeSH
• Medication Adherence psychology   MeSH
• Antihypertensive Agents * analysis   therapeutic use   MeSH
• Biomarkers * blood   urine   MeSH
• Chromatography, Liquid methods   MeSH
• Adult MeSH
• Hypertension * diagnosis   drug therapy   epidemiology   psychology   MeSH
• Blood Pressure drug effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Medication Therapy Management standards   MeSH
• Blood Pressure Determination methods   psychology   MeSH
• Aged MeSH
• Outcome and Process Assessment, Health Care MeSH
• Quality Improvement MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• United Kingdom epidemiology   MeSH
• Names of Substances
• Antihypertensive Agents * MeSH
• Biomarkers * MeSH

Catheter-based renal denervation (RD) has been introduced recently as a potentially effective invasive treatment of refractory hypertension. The proportion of patients with severe hypertension suitable for RD is not clear. The aim of this study was to identify what percentage of patients has truly resistant essential hypertension and are thus potentially eligible for RD. We investigated 205 consecutive patients referred to a university hypertension center for severe hypertension within 12 months. Ambulatory 24-h blood pressure (BP) monitoring (24 h ABPM), secondary hypertension screening and compliance to treatment testing (by use of plasma drug level measurements) were performed in all patients. Fifty-seven patients (27.8%) did not have truly resistant hypertension (RH) based on clinical BP. Among the remaining 122 patients (59.5%) with RH confirmed by 24 h ABPM, 50 patients (24.4% of the original cohort) had a secondary cause of hypertension and in 27 (13.2%) non-compliance to treatment was confirmed. Thus, only 45 patients (22%) had truly resistant essential hypertension and were considered for RD. Only one-third (n=15, 7.3% of the original cohort) was, however, finally referred for RD (14 were excluded due to contraindications for RD and 16 refused the invasive treatment). In conclusion, thorough examination of severe hypertension including 24 h ABPM, secondary hypertension exclusion and drug compliance testing before considering RD reveals that majority of these patients are not suitable for RD. Specifically, compliance to treatment testing should be mandatory in order to identify eligible candidates for RD.

• MeSH
• Medication Adherence * MeSH
• Blood Pressure Monitoring, Ambulatory MeSH
• Antihypertensive Agents therapeutic use   MeSH
• Autonomic Denervation methods   MeSH
• Adult MeSH
• Hypertension diagnosis   drug therapy   physiopathology   surgery   MeSH
• Referral and Consultation MeSH
• Blood Pressure drug effects   MeSH
• Kidney innervation   MeSH
• Drug Resistance * MeSH
• Middle Aged MeSH
• Humans MeSH
• Drug Monitoring MeSH
• Hospitals, University MeSH
• Predictive Value of Tests MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Eligibility Determination MeSH
• Patient Selection MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH
• Names of Substances
• Antihypertensive Agents MeSH