Adherence to Antihypertensive Medication in Treatment-Resistant Hypertension Undergoing Renal Denervation.
Adherence to Antihypertensive Medication in Treatment-Resistant Hypertension Undergoing Renal Denervation.
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DOI：
10.1161/jaha.115.002343
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发表时间：
2016-02-12
影响因子：
5.4
通讯作者：
Toennes SW
中科院分区：
文献类型：
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作者：
Schmieder RE;Ott C;Schmid A;Friedrich S;Kistner I;Ditting T;Veelken R;Uder M;Toennes SW
坚持药物治疗已被多次提出是难治性高血压（TRH）的主要原因；然而，治疗决策（例如用肾去神经术治疗 TRH）取决于对依从性的准确判断。我们仔细分析了肾去神经术前后的药物依从率及其对血压（BP）控制的影响。两项前瞻性观察性研究纳入了 80 名 TRH 患者，评估了去肾神经术潜在的抗高血压和肾保护作用的差异。为了将处方药物与实际药物摄入量（代表依从性的衡量标准）进行比较，我们分析了基线和肾去神经支配后 6 个月收集的尿液样本中的抗高血压化合物或代谢物（通过液相色谱-质谱法）。除诊室血压外，还评估了 24 小时动态血压和中心血流动力学（中心收缩压、中心脉压）。 80 名患者中有 79 名获得了对尿液代谢物分析的知情同意书。分别有 44 名 (56%) 和 52 名 (66%) 患者在基线时和去肾神经术后 6 个月时检测到所有抗高血压药物的实际摄入量；分别有 22 名 (28%) 和 17 名 (22%) 名患者缺少 1 种药物，分别有 13 名 (16%) 和 10 名 (13%) 名患者缺少 ≥ 2 种药物。基线时，非依从性患者的 24 小时动态血压 (P=0.049) 和中心收缩压 (P=0.012) 较高。总体而言，依从性没有显着变化（McNemar-Bowker 检验，P=0.362）。 21 名患者的依从性有所增加，11 名患者的依从性有所下降。去肾神经术后6个月依从性稳定的患者(n=41, -7±13 mm Hg)与依从性增加的患者(n=21, -10±13 mm Hg)和依从性降低的患者(n=11, -7±14 mm Hg)的24小时动态血压降低没有差异(P>0.20)。我们的研究受到样本量相对较小的限制，并且可能受到我们大学中心（德国巴伐利亚北部）特定健康环境的限制。 TRH 患者不遵守药物治疗的比例相对较低：6 名 TRH 患者中约有 1 名没有服用≥2 种处方药物。去肾神经支配后，依从模式没有显着改变，并且对观察到的总体血压变化没有影响，这支持了去肾神经支配是 TRH 患者的有效治疗方法的概念。 网址：https://www.clinicaltrials.gov。唯一标识符：NCT00888433、NCT01442883 和 NCT01687725。
Adherence to medication has been repeatedly proposed to represent a major cause of treatment‐resistant hypertension (TRH); however, treatment decisions such as treating TRH with renal denervation depend on accurate judgment of adherence. We carefully analyzed adherence rates to medication before and after renal denervation and its effect on blood pressure (BP) control. Eighty patients with TRH were included in 2 prospective observational studies that assessed the difference of potential antihypertensive and nephroprotective effects of renal denervation. To compare prescribed with actual medication intake (representing a measure of adherence), we analyzed urine samples collected at baseline and at 6 months after renal denervation for antihypertensive compounds or metabolites (by liquid chromatography–mass spectrometry). In addition to office BP, 24‐hour ambulatory BP and central hemodynamics (central systolic pressure, central pulse pressure) were assessed. Informed consent for analyses of urine metabolites was obtained from 79 of 80 patients. Actual intake of all antihypertensive drugs was detected at baseline and at 6 months after renal denervation in 44 (56%) and 52 (66%) patients, respectively; 1 drug was missing in 22 (28%) and 17 (22%) patients, respectively, and ≥2 drugs were missing in 13 (16%) and 10 (13%) patients, respectively. At baseline, 24‐hour ambulatory BP (P=0.049) and central systolic BP (P=0.012) were higher in nonadherent patients. Adherence did not significantly change overall (McNemar‐Bowker test, P=0.362). An increase in adherence was observed in 21 patients, and a decrease was observed in 11 patients. The decrease in 24‐hour ambulatory BP was not different in those with stable adherence 6 months after renal denervation (n=41, −7±13 mm Hg) compared with those with increased adherence (n=21, −10±13 mm Hg) and decreased adherence (n=11, −7±14 mm Hg) (P>0.20). Our study is limited by the relatively small sample size and potentially by the specific health environment of our university center (Northern Bavaria, Germany). Nonadherence to medication among patients with TRH was relatively low: ≈1 of 6 patients with TRH did not take ≥2 of the prescribed drugs. Adherence pattern did not change significantly after renal denervation and had no impact on the overall observed BP changes, supporting the concept that renal denervation is an effective treatment in patients with TRH. URL: https://www.clinicaltrials.gov. Unique identifiers: NCT00888433, NCT01442883 and NCT01687725.