June 20, 2017
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Many patients nonadherent to antihypertensive treatment

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About one-third of adults with hypertension are not adhering to their antihypertensive medications, according to data from European populations.

“Despite the documented effectiveness of antihypertensive treatment, targets of BP are achieved only in 40% to 50% of patients with hypertension, and high BP is the leading single risk factor for health loss and premature death globally, exceeding the burden of disease attributable to smoking and excessive weight,” Pankaj Gupta, DPB, MSC, FRCPath, FRCP, of the department of cardiovascular sciences at the University of Leicester, United Kingdom, and colleagues wrote. “Nonadherence to antihypertensive treatment is increasingly recognized as a main contributor to suboptimal BP control at the population level, high prevalence of resistant hypertension and high financial burden for health care.”

The researchers used a high-performance liquid chromatography-tandem mass spectrometry of urine and serum to detect nonadherence. They studied participants (n = 1,348) from the U.K. and the Czech Republic who were referred to the study if they were suspected of nonadherence by a physician.

In the U.K. cohort, 41.6% of participants were nonadherent to their antihypertensive medications and in the Czech cohort, 31.5% were nonadherent. Those who were nonadherent were more likely to be younger and female.

Additionally, 14.5% of the U.K. cohort and 12% of the Czech cohort were not taking any medications.

Each additional antihypertensive medication led to an 85% increase in nonadherence in the U.K. cohort and 77% increase in the Czech cohort (P < .001 for both).

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Among the five classes of antihypertensives, nonadherence was highest in diuretics.

The researchers built predictive models for nonadherence, factoring in age, sex, number of prescribed antihypertensive medications and prescribed diuretics. For the Czech model tested on the U.K. data, the area under the curve was 0.708, and for the U.K. model tested on the Czech data, the area under the curve was 0.756.

“Biochemical assessment of nonadherence to antihypertensive medications is a useful diagnostic test in management of patients with hypertension, in particular those with suboptimal BP control,” the researchers wrote. “A wider use of this this test may prevent many unnecessary investigations and treatment escalations.”

In an accompanying editorial, David J. Hyman, MD, MPH, chief of general medicine at

Baylor College of Medicine, Texas, expressed concern over the way the study population was chosen through referrals of patients suspected of nonadherence.

“More importantly, the observation that nonadherence is associated with the number of medications by itself may not lend support to the use of combination drugs. Indeed, it is likely the failure to control BP with multiple medications — medications that were sequentially added because of continued high BP despite the previous intensification of therapy — that would most likely elicit a referral,” Hyman wrote. – by Cassie Homer

Disclosure: Gupta and Hyman report no relevant financial disclosures. Please see the full study for other researchers’ relevant financial disclosures.