title: How to Screen for Non-Adherence to Antihypertensive Therapy.
abstract: The quality of assessment of non-adherence to treatment in hypertensive is poor. Within this review, we discuss the different methods used to assess adherence to blood-pressure-lowering medications in hypertension patients. Subjective reports such as physicians' perceptions are inaccurate, and questionnaires completed by patients tend to overreport adherence and show a low diagnostic specificity. Indirect objective methods such as pharmacy database records can be useful, but they are limited by the robustness of the recorded data. Electronic medication monitoring devices are accurate but usually track adherence to only a single medication and can be expensive. Overall, the fundamental issue with indirect objective measures is that they do not fully confirm ingestion of antihypertensive medications. Detection of antihypertensive medications in body fluids using liquid chromatography-tandem mass spectrometry is currently, in our view, the most robust and clinically useful method to assess non-adherence to blood-pressure-lowering treatment. It is particularly helpful in patients presenting with resistant, refractory or uncontrolled hypertension despite the optimal therapy. We recommend using this diagnostic strategy to detect non-adherence alongside a no-blame approach tailoring support to address the perceptions (e.g. beliefs about the illness and treatment) and practicalities (e.g. capability and resources) influencing motivation and ability to adhere.
authors.affiliation: Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK.|National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.|British Heart Foundation Cardiovascular Research Centre, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK.|National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.|British Heart Foundation Cardiovascular Research Centre, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Behavioral Medicine, School of Pharmacy, University College London, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Horne
authors.affiliation: Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Buchanan
authors.affiliation: Institute of Cardiovascular Science, University College London, London, UK.|National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK.
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
authors.affiliation: Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. maciej.tomaszewski@manchester.ac.uk.|Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. maciej.tomaszewski@manchester.ac.uk.
authors.forename: Maciej
authors.initials: M
authors.lastname: Tomaszewski
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D055118:Medication Adherence; D011795:Surveys and Questionnaires
chemical_list: D000959:Antihypertensive Agents
keywords: Blood pressure medication; Hypertension; Non-adherence; Uncontrolled hypertension