Cor Vasa 2011, 53(8-9):429-432 | DOI: 10.33678/cor.2011.109

How to assess non-compliance with the pharmacotherapy in severe resistant hypertension?

Branislav Štrauch^1,*, Lukáš Chytil², Ivana Kurcová², Ondřej Petrák¹, Tomáš Zelinka¹, Ján Rosa¹, Zuzana Šomlóová¹, Robert Holaj¹, Jiří Widimský¹

¹ Centrum pro výzkum, diagnostiku a léčbu arteriální hypertenze, III. interní klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

² Ústav soudního lékařství a toxikologie, Toxikologické oddělení, 1. LF UK a VFN, Praha, Česká republika

Resistant arterial hypertension is defined by impossibility to normalize blood pressure to normal limits (140/90 mmHg) using at least combination of three antihypertensive drugs including a thiazide diuretic. Exclusion of potentially reversible secondary hypertension is needed in patients with resistant hypertension. Partial or total non-compliance of patients with regularly intake antihypertensive drugs is, besides white coat phenomenon, a frequent form of pseudoresistance to the treatment. There are many factors which contribute to the level of adherence, including the characteristics of the patients, prescribed medication and rarely prescribing physicians. Although many methods for assessment of compliance have been used in our practice, no golden standard was determined. A rapid and sensitive method using liquid chromatography-tandem mass spectrometry (LC-MS/MS) for determination of antihypertensive drugs in human serum has been developed recently. Quantitative determination of following antihypertensive drugs is currently available at the Institute of Forensic Medicine and Toxicology, 1st Faculty of Medicine, Charles University in Prague: amlodipine, verapamil, metoprolol, betaxolol, bisoprolol, hydrochlorothiazide, losartan, telmisartan, doxazosine, rilmenidine, ramiprilate a perindoprilate. Qualitative determination of canrenoate is also available. For correct interpretation of measured data, good knowledge of pharmacokinetic characteristics of the drugs is needed to be able to determine appropriate timing of blood sampling. 120 hospitalized patients (48 females) with resistant hypertension admitted for exclusion of a secondary cause and 73 out-patients (35 females) with resistant hypertension investigated in our out-patient department were investigated during 2009-2010. While in hospitalized patients all antihypertensive drugs were positive in 83%, we observed a surprisingly very low compliance with the antihypertensive treatment among investigated out-patients with severe hypertension - all drugs were positive only in 39% of them. In conclusion, the evaluation of antihypertensive drugs concentrations is a useful and very precise method for assessment of a possible non-compliance with the antihypertensive treatment and should be, despite its expensiveness, more widely used in our practice to reveal non-compliance in patients with resistant hypertension.

Keywords: Resistant hypertension; Compliance with antihypertensive treatment; Liquid chromatography-tandem mass spectrometry

Published: August 1, 2011  Show citation