title: Blood pressure reductions following catheter-based renal denervation are not related to improvements in adherence to antihypertensive drugs measured by urine/plasma toxicological analysis.
abstract: Renal denervation can reduce blood pressure in patients with uncontrolled hypertension. The adherence to prescribed antihypertensive medication following renal denervation is unknown. This study investigated adherence to prescribed antihypertensive treatment by liquid chromatography-high resolution tandem mass spectrometry in plasma and urine at baseline and 6 months after renal denervation in 100 patients with resistant hypertension, defined as baseline office systolic blood pressure ≥140 mmHg despite treatment with ≥3 antihypertensive agents. At baseline, complete adherence to all prescribed antihypertensive agents was observed in 52 patients, 46 patients were partially adherent, and two patients were completely non-adherent. Baseline office blood pressure was 167/88 ± 19/16 mmHg with a corresponding 24-h blood pressure of 154/86 ± 15/13 mmHg. Renal denervation significantly reduced office and ambulatory blood pressure at 6-month follow-up by 15/5 mmHg (p < 0.001/p < 0.001) and 8/4 mmHg (p < 0.001/p = 0.001), respectively. Mean adherence to prescribed treatment was significantly reduced from 85.0 % at baseline to 80.7 %, 6 months after renal denervation (p = 0.005). The blood pressure decrease was not explained by improvements in adherence following the procedure. Patients not responding to treatment significantly reduced their drug intake following the procedure. Adherence was highest for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta blockers (>90 %) and lowest for vasodilators (21 %). In conclusion, renal denervation can reduce office and ambulatory blood pressure in patients with resistant hypertension despite a significant reduction in adherence to antihypertensive treatment after 6 months.
authors: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Germany. Sebastian.Ewen@uks.eu.
authors: Sebastian
authors: S
authors: Ewen
authors: Abteilung für Experimentelle und Klinische Pharmakologie, Universität des Saarlandes, Homburg/Saar, Germany.
authors: Markus R
authors: MR
authors: Meyer
authors: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Germany.
authors: Bodo
authors: B
authors: Cremers
authors: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Germany.
authors: Ulrich
authors: U
authors: Laufs
authors: Abteilung für Experimentelle und Klinische Pharmakologie, Universität des Saarlandes, Homburg/Saar, Germany.
authors: Andreas G
authors: AG
authors: Helfer
authors: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Germany.
authors: Dominik
authors: D
authors: Linz
authors: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Germany.
authors: Ingrid
authors: I
authors: Kindermann
authors: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Germany.
authors: Christian
authors: C
authors: Ukena
authors: Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland.
authors: Michel
authors: M
authors: Burnier
authors: Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik, Universität des Saarlandes, Homburg/Saar, Germany.
authors: Stefan
authors: S
authors: Wagenpfeil
authors: Abteilung für Experimentelle und Klinische Pharmakologie, Universität des Saarlandes, Homburg/Saar, Germany.
authors: Hans H
authors: HH
authors: Maurer
authors: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Germany.
authors: Michael
authors: M
authors: Böhm
authors: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Germany. Felix.Mahfoud@uks.eu.
authors: Felix
authors: F
authors: Mahfoud
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D002853:Chromatography, Liquid / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D013562:Sympathectomy / Q000379:methods*; D053719:Tandem Mass Spectrometry / Q000379:methods
chemical_list: D000959:Antihypertensive Agents
keywords: Adherence to drug treatment; Liquid chromatography–high resolution tandem mass spectrometry; Renal denervation; Resistant hypertension; Sympathetic nervous system