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.

• Klíčová slova
• adherence, antihypertensive agents, blood pressure, chromatography, liquid, hypertension,
• MeSH
• adherence k farmakoterapii psychologie   MeSH
• antihypertenziva * analýza   terapeutické užití   MeSH
• biologické markery * krev   moč   MeSH
• chromatografie kapalinová metody   MeSH
• dospělí MeSH
• hypertenze * diagnóza   farmakoterapie   epidemiologie   psychologie   MeSH
• krevní tlak účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• management farmakoterapie normy   MeSH
• měření krevního tlaku metody   psychologie   MeSH
• senioři MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• zlepšení kvality MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Spojené království epidemiologie   MeSH
• Názvy látek
• antihypertenziva * MeSH
• biologické markery * MeSH

PURPOSE OF REVIEW: Resistant hypertension is a common clinical situation. Identification of true resistant hypertension (using 24-h ambulatory blood pressure monitoring to exclude white coat phenomenon, excluding secondary causes and non-adherence to treatment) is important mostly because of the application of a proper therapeutic approach and the higher cardiovascular risk of these patients. This review surveys recent studies, with a focus on mineralocorticoid receptor antagonists, including spironolactone, in the treatment of resistant hypertension. RECENT FINDINGS: A range of randomized and non-randomized studies have proved the efficacy of mineralocorticoid receptor antagonists, including spironolactone. However, long-term mortality studies are still missing for the hypertensive population. In the case of spironolactone side effects, higher doses of amiloride or eplerenone might be used. Based on available data and our own experience, spironolactone (mineralocorticoid receptor antagonists) should be involved, if tolerated, in combination therapy in true resistant hypertensive patients. Spironolactone still represents primary therapeutic modality under specific conditions of primary aldosteronism.

• Klíčová slova
• Mineralocorticoid receptor antagonists, Resistant hypertension, Spironolactone,
• MeSH
• diuretika terapeutické užití   MeSH
• hypertenze farmakoterapie   MeSH
• léková rezistence MeSH
• lidé MeSH
• metaanalýza jako téma MeSH
• randomizované kontrolované studie jako téma MeSH
• spironolakton terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• diuretika MeSH
• spironolakton MeSH