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Measuring adherence to therapy in apparent treatment-resistant hypertension: a feasibility study in Irish primary care

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dc.contributor.author Hayes, Peter
dc.contributor.author Casey, Monica
dc.contributor.author Glynn, Liam G.
dc.contributor.author Molloy, Gerard J.
dc.contributor.author Durand, Hannah
dc.contributor.author O'Brien, Eoin
dc.contributor.author Dolan, Eamon
dc.contributor.author Kishor,Das,
dc.contributor.author Newell, John
dc.contributor.author Finn, David
dc.contributor.author Harhen, Brendan
dc.contributor.author Connelly, Ann
dc.contributor.author Murphy, Andrew W.
dc.date.accessioned 2020-09-03T13:44:43Z
dc.date.available 2020-09-03T13:44:43Z
dc.date.issued 2019
dc.identifier.issn 1478-5242
dc.identifier.uri http://hdl.handle.net/10344/9180
dc.description peer-reviewed en_US
dc.description.abstract BACKGROUND: Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled blood pressure (BP) in patients taking three or more antihypertensive medications. Some patients will have true treatment-resistant hypertension, some undiagnosed secondary hypertension, while others have pseudo-resistance. Pseudo-resistance occurs when non-adherence to medication, white-coat hypertension (WCH), lifestyle, and inadequate drug dosing are responsible for the poorly controlled BP. AIM: To examine the feasibility of establishing non-adherence to medication, for the first time in primary care, using mass spectrometry urine analysis. Operationalisation would be established by at least 50% of patients participating and 95% of samples being suitable for analysis. Clinical importance would be confirmed by >10% of patients being non-adherent. DESIGN AND SETTING: Eligible patients with aTRH (n = 453) in 15 university research-affiliated Irish general practices were invited to participate. METHOD: Participants underwent mass spectrometry urine analysis to test adherence and ambulatory BP monitoring (ABPM) to examine WCH. RESULTS: Of the eligible patients invited, 52% (n = 235) participated. All 235 urine samples (100%) were suitable for analysis: 174 (74%) patients were fully adherent, 56 (24%) partially adherent, and five (2%) fully non-adherent to therapy. A total of 206 patients also had ABPM, and in total 92 (45%) were categorised as pseudo-resistant. No significant associations were found between adherence status and patient characteristics or drug class. CONCLUSION: In patients with aTRH, the authors have established that it is feasible to examine non-adherence to medications using mass spectrometry urine analysis. One in four patients were found to be partially or fully non-adherent. Further research on how to incorporate this approach into individual patient consultations and its associated cost-effectiveness is now appropriate. en_US
dc.language.iso eng en_US
dc.publisher Royal College of General Practitioners en_US
dc.relation.ispartofseries British Journal of General Practice;69 (686), e621-e628
dc.rights © 2019 Royal College of General Practitioners en_US
dc.subject hypertension en_US
dc.subject primary care en_US
dc.subject pseudo-resistance en_US
dc.subject treatment adherence en_US
dc.subject urinalysis en_US
dc.title Measuring adherence to therapy in apparent treatment-resistant hypertension: a feasibility study in Irish primary care en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.date.updated 2020-09-03T11:54:40Z
dc.description.version PUBLISHED
dc.identifier.doi 10.3399/bjgp19X705077
dc.contributor.sponsor HRB en_US
dc.relation.projectid HRA-POR-2014-615 en_US
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US
dc.internal.rssid 2927691
dc.internal.copyrightchecked Yes
dc.description.status peer-reviewed


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