Measuring adherence to antihypertensive medication using an objective test in older adults attending primary care: cross-sectional study.
James Peter SheppardAli AlbasriPankaj GuptaPrashanth PatelKamlesh Khunti F MedSciUna MartinRichard J McManusF D Richard HobbsPublished in: Journal of human hypertension (2021)
Analysis of urine samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS) has previously revealed high rates of non-adherence to antihypertensive medication. It is unclear whether these rates represent those in the general population. This study aimed to investigate whether it is feasible to collect urine samples in a primary care setting and analyse them using LC-MS/MS to detect non-adherence to antihypertensive medication. This study used a prospective, observational cohort design. Consecutive patients were recruited opportunistically from five general practices in UK primary care. They were aged ≥65 years with hypertension and had at least one antihypertensive prescription. Participants were asked to provide a urine sample for analysis of medication adherence. Samples were sent to a laboratory via post and analysed using LC-MS/MS. Predictors of adherence to medication were explored with multivariable logistic regression. Of 349 consecutive patients approached for the study, 214 (61.3%) gave informed consent and 191 (54.7%) provided a valid urine sample for analysis. Participants were aged 76.2 ± 6.6 years and taking a median of 2 antihypertensive medications (IQR 1-3). A total of 27/191 participants (14.2%) reported not taking all of their medications on the day of urine sample collection. However, LC-MS/MS analysis of samples revealed only 4/27 (9/191 in total; 4.7%) were non-adherent to some of their medications. Patients prescribed more antihypertensive medications were less likely to be adherent (OR 0.24, 95%CI 0.09-0.65). Biochemical testing for antihypertensive medication adherence is feasible in routine primary care, although non-adherence to medication is generally low, and therefore widespread testing is not indicated.
Keyphrases
- primary care
- blood pressure
- end stage renal disease
- healthcare
- ejection fraction
- newly diagnosed
- chronic kidney disease
- liquid chromatography tandem mass spectrometry
- peritoneal dialysis
- hypertensive patients
- prognostic factors
- type diabetes
- emergency department
- ms ms
- physical activity
- mass spectrometry
- clinical practice
- cross sectional
- tertiary care