Therapeutic Drug Monitoring to Assess Drug Adherence in Assumed Resistant Hypertension: A Comparison With Directly Observed Therapy in 3 Nonadherent Patients
Therapeutic Drug Monitoring to Assess Drug Adherence in Assumed Resistant Hypertension: A Comparison With Directly Observed Therapy in 3 Nonadherent Patients
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DOI：
10.1097/fjc.0000000000000602
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发表时间：
2018-08-01
影响因子：
3
通讯作者：
Versmissen, Jorie
中科院分区：
文献类型：
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作者：
Feyz, Lida;Bahmany, Soma;Versmissen, Jorie
顽固性高血压是一种常见的健康问题，导致心血管预防效果欠佳。大量顽固性高血压患者的药物依从性较差，这解释了他们对治疗的抵抗力。我们将3例患者在多个时间点的直接观察治疗（DOT）与治疗药物监测（TDM）相结合，以实现对血压（BP）和药物水平的广泛反馈。在入院期间，每隔5分钟（服药前后）和每隔30分钟（夜间）用自动振荡装置测量一次血压。在不同时间点（t = in hours; t =服药后0、2、4、6、12、24 h）采集血样。DOT是在医生的监督下进行的。在3例患者中，2例患者在DOT后自动血压分别下降-10/0和-5/-5 mm Hg。几种药物或活性代谢物的血浆药物水平在t = 0时为0，而在观察摄入后t = 24小时血浆药物水平为阳性。我们建议在临床实践中更频繁地使用TDM并重复测量血压，因为这是一种方便、客观的测量方法，并确保实际药物水平反映了测量时的血压。
Resistant hypertension is a common health problem leading to suboptimal cardiovascular prevention. A large number of patients with resistant hypertension have poor medication adherence explaining their assumed resistance to therapy. We combined directly observed therapy (DOT) with therapeutic drug monitoring (TDM) in 3 patients at several time points to enable an extensive feedback on blood pressure (BP) and drug levels. BP was measured with an automatic oscillatory device at regular intervals of 5 minutes (directly before and after drug intake) and at 30-minute intervals (at night) during admission. Blood samples were obtained at different time points (t = in hours; t = 0, 2, 4, 6, 12, and 24 hours after drug intake). DOT was performed under supervision of the physician. In 2 of the 3 patients, automated BP decreased directly after DOT, -10/0 and -5/-5 mm Hg, respectively. Plasma drug levels for several drugs or active metabolites were 0 at t = 0, whereas plasma levels were positive at t = 24 hours after observed intake. We recommend a more frequent use of TDM combined with repeated BP measurements in clinical practice because this is a convenient, objective method of measurement and to ensure that actual drug levels reflect the BP at the time of measurement.