title: Screening for non-adherence to antihypertensive treatment as a part of the diagnostic pathway to renal denervation.
abstract: Renal denervation is a potential therapeutic option for resistant hypertension. A thorough clinical assessment to exclude reversible/spurious causes of resistance to antihypertensive therapy is required prior to this procedure. The extent to which non-adherence to antihypertensive treatment contributes to apparent resistance to antihypertensive therapy in patients considered for renal denervation is not known. Patients (n=34) referred for renal denervation entered the evaluation pathway that included screening for adherence to antihypertensive treatment by high-performance liquid chromatography-tandem mass spectrometry-based urine analysis. Biochemical non-adherence to antihypertensive treatment was the most common cause of non-eligibility for renal denervation-23.5% of patients were either partially or completely non-adherent to prescribed antihypertensive treatment. About 5.9% of those referred for renal denervation had admitted non-adherence prior to performing the screening test. Suboptimal pharmacological treatment of hypertension and 'white-coat effect' accounted for apparently resistant hypertension in a further 17.7 and 5.9% of patients, respectively. Taken together, these three causes of pseudo-resistant hypertension accounted for 52.9% of patients referred for renal denervation. Only 14.7% of referred patients were ultimately deemed eligible for renal denervation. Without biochemical screening for therapeutic non-adherence, the eligibility rate for renal denervation would have been 38.2%. Non-adherence to antihypertensive treatment and other forms of therapeutic pseudo-resistance are by far the most common reason of 'resistant hypertension' in patients referred for renal denervation. We suggest that inclusion of biochemical screening for non-adherence to antihypertensive treatment may be helpful in evaluation of patients with 'resistant hypertension' prior to consideration of renal denervation.
authors.affiliation: Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK.|Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.|NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.
authors.forename: P
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK.|Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.|NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.
authors.forename: P K C
authors.initials: PK
authors.lastname: Gupta
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.|University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: C M J
authors.initials: CM
authors.lastname: White
authors.affiliation: University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: A G
authors.initials: AG
authors.lastname: Stanley
authors.affiliation: Institute of Cardiovascular Science, University College London, London, UK.|National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Williams
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.|NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.|University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: M
authors.initials: M
authors.lastname: Tomaszewski
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use* / Q000652:urine; D001794:Blood Pressure / Q000187:drug effects*; D002851:Chromatography, High Pressure Liquid; D000066491:Clinical Decision-Making; D016903:Drug Monitoring / Q000379:methods*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine; D007668:Kidney / Q000098:blood supply*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012077:Renal Artery / Q000294:innervation*; D012189:Retrospective Studies; D013562:Sympathectomy / Q000379:methods*; D053719:Tandem Mass Spectrometry; D016482:Urinalysis
chemical_list: D000959:Antihypertensive Agents