title: Comparison of Morisky Medication Adherence Scale with therapeutic drug monitoring in apparent treatment-resistant hypertension.
abstract: The Morisky Medication Adherence Scale (MMAS-8) is a questionnaire developed for screening of non-adherence in patients with several chronic conditions, including uncomplicated hypertension. However, its accuracy in predicting non-adherence in patients with apparent treatment-resistant hypertension (a-TRH) is not known. Accordingly, we performed a retrospective study in 47 patients with a-TRH who had completed the eight-item MMAS during the initial clinic visit. Non-adherence was defined as presence of undetected serum levels of at least one prescribed antihypertensive drug by therapeutic drug monitoring. We found that 26% of patients were considered to have low adherence score (<6), while the actual prevalence of non-adherence was 51% by therapeutic drug monitoring. Sensitivity of the MMAS-8 was 26% (95% confidence interval, 10.3%-48.4%) with specificity of 75% (95% confidence interval, 53.3%-90.2%). By multivariate analysis, the MMAS-8 score was not an independent predictor of non-adherence, while certain clinical parameters such as heart rate were found to be independent predictors of non-adherence. Our study suggested limited accuracy of the MMAS-8 in detecting medication non-adherence in a-TRH.
authors.affiliation: Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Ambarish
authors.initials: A
authors.lastname: Pandey
authors.affiliation: Internal Medicine Department, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Fayez
authors.initials: F
authors.lastname: Raza
authors.affiliation: Hypertension Section, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Velasco
authors.affiliation: Internal Medicine Department, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Brinker
authors.affiliation: Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Colby
authors.initials: C
authors.lastname: Ayers
authors.affiliation: Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Sandeep R
authors.initials: SR
authors.lastname: Das
authors.affiliation: Department of Community Health Sciences, Univeristy of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Morisky
authors.affiliation: Internal Medicine Department, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.affiliation: Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX, USA; Hypertension Section, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: wanpen.vongpatanasin@utsouthwestern.edu.
authors.forename: Wanpen
authors.initials: W
authors.lastname: Vongpatanasin
mesh_terms: D000367:Age Factors; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D019540:Area Under Curve; D015331:Cohort Studies; D016001:Confidence Intervals; D016903:Drug Monitoring / Q000379:methods*; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012737:Sex Factors; D011795:Surveys and Questionnaires
chemical_list: D000959:Antihypertensive Agents
keywords: Blood pressure control; self reported adherence; serum drug levels