How to Screen for Non-Adherence to Antihypertensive Therapy

Gupta, Pankaj; Patel, Prashanth; Horne, Robert; Buchanan, Heather; Williams, Bryan; Tomaszewski, Maciej

doi:10.1007/s11906-016-0697-7

Cited by 74 publications

(63 citation statements)

References 59 publications

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“…Recently, it was proposed to measure antihypertensive drug levels in the patient by means of liquid chromatography-tandem mass spectrometry. 23 However, this method is expensive and can detect only those individuals who have not taken medication for a prolonged period of time, not the ones who take their drugs off and on. To get at least some insight in patients' behavior, we used, before inclusion, Medication Events Monitoring System track caps 24 in a small subset of patients, allowing us to include only those with adequate adherence.…”

Section: Limitationsmentioning

confidence: 99%

Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy

et al. 2017

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Baroreflex activation therapy (BAT) is a novel way of treating hypertensive patients who respond inadequately to medical therapy. After short-term human studies had shown that electric stimulation of the carotid sinus can lower blood pressure, 1,2 the DEBuT-HT study (Device-Based Therapy of Hypertension) demonstrated a substantial and sustained reduction in blood pressure over a period of 3 months in treatment-resistant hypertensive patients.3 Subsequently, the Rheos Pivotal Trial evaluated the effect of BAT in a doubleblind, randomized, prospective, sham-controlled trial in which patients were randomized to receive BAT either immediately or 6 months after implantation of the Rheos device.4 This study also showed that BAT can safely reduce blood pressure in patients with resistant hypertension in the long run. At this point, however, the technique has not yet been introduced into clinical practice. One of the drawbacks is that it is an invasive method, and there is still some concern as to whether efficacy is sustained over longer periods of time. In this regard, the 3 trials that have evaluated this device-based therapy (the US Rheos Feasibility Trial, the DEBuT-HT Trial, and the Rheos Pivotal Trial) offered a unique opportunity to address this problem. Indeed, after the formal completion of both trials, patients were followed up at regular intervals to assess the long-term effect of BAT on blood pressure and heart rate. The purpose of the present report, therefore, is to describe the follow-up results of BAT during a 6-year period. MethodsThe present analyses are based on the group of patients who were included in the US Rheos Feasibility Trial, 2 the DEBuT-HT Trial, 3 and See Editorial Commentary, pp 782-784Abstract-Baroreflex activation therapy is a novel technique for treating patients with resistant hypertension. Although short-term studies have demonstrated that it lowers blood pressure, long-term results have not yet been reported. The aim of the present study is to assess the long-term efficacy and safety of baroreflex activation therapy. Long-term followup data were analyzed from all patients who had been included in 1 of the 3 trials that focused on treatment-resistant hypertensive patients. Altogether, 383 patients were available for analysis: 143 of these had completed 5 years of followup and 48 patients had completed 6 years of follow-up. In the entire cohort, office systolic blood pressure fell from 179±24 mm Hg to 144±28 mm Hg (P<0.0001), whereas office diastolic pressure dropped from 103±16 mm Hg to 85±18 mm Hg (P<0.0001). Heart rate fell from 74±15 beats per minute to 71±13 beats per minute (P<0.02). The effect of baroreflex activation therapy is greater than average in patients with signs of heart failure and less than average in patients with isolated systolic hypertension. In ≈25% of patients, it was possible to reduce the number of medications from a median of 6 to a median of 3. Temporary side effects, related to either the surgical procedure or the cardiovascular instability, do occur, bu...

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Section: Limitationsmentioning

confidence: 99%

Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy

et al. 2017

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“…To increase patient involvement by self-monitoring of blood pressure has been shown to increase treatment adherence and improve blood pressure control. 17 6. Assessing medication adherence by direct biochemical measurement or electronic pillbox and discussing the results with the patient ("adherence counseling") have been shown to improve adherence to antihypertensive medication and to overcome clinical inertia, that is, a lack of treatment intensification despite uncontrolled hypertension.…”

Section: Published In This Issuementioning

confidence: 99%

“…6,16 Since subjective estimates of nonadherence by the treating physician are widely inaccurate, and questionnaires overreport adherence, assessing medication adherence by direct biochemical measurement (or electronic pillbox) should become part of daily practice in treating hypertensive patients. 17 6. Consider treatment ("out of pocket") cost for antihypertensive medication, especially, if there is no complete coverage for health care cost by health insurance or by the state.…”

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confidence: 99%

Nonadherence in patients with hypertensive emergency or hypertensive urgency

Krämer

Benck

et al. 2018

J of Clinical Hypertension

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“…8 Non-adherence to antihypertensive treatments is common, and is much higher in patients with resistant hypertension than in the general hypertensive population. 9 In addition, non-adherence is difficult to monitor because most objective measures do not confirm ingestion of the medication. 9 Therapeutic interventions that increase adherence are therefore of great value.…”

Section: Hypertensionmentioning

confidence: 99%

“…9 In addition, non-adherence is difficult to monitor because most objective measures do not confirm ingestion of the medication. 9 Therapeutic interventions that increase adherence are therefore of great value. Single pill combinations in hypertension have been associated with increased patient adherence.…”

Section: Hypertensionmentioning

confidence: 99%

Practical Applications for Single Pill Combinations in the Cardiovascular Continuum

Iellamo

Werdan

Rosano

et al. 2017

Cardiac Failure Review

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Despite the availability of new drugs and devices, the treatment of cardiovascular disease remains suboptimal. Single-pill combination therapy offers a number of potential advantages. It can combine different classes of drugs to increase efficacy while mitigating the risks of treatment-related adverse events, reduce pill burden, lower medical cost, and improve patient adherence. Furthermore, in hypertension, single pill combinations include standard to lower doses of each drug than would be necessary to achieve goals with monotherapy, which may explain their better tolerability compared with higher dose monotherapy. Combination therapy is now established in the treatment of hypertension. In ischaemic heart disease, the concept of a preventative polypill has been studied, but its benefits have not been established conclusively. However, the combination of ivabradine and beta-blockers has proven efficacy in patients with stable angina pectoris. This combination has also demonstrated benefits in patients with chronic heart failure.

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How to Screen for Non-Adherence to Antihypertensive Therapy

Cited by 74 publications

References 59 publications

Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy

Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy

Nonadherence in patients with hypertensive emergency or hypertensive urgency

Practical Applications for Single Pill Combinations in the Cardiovascular Continuum

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