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Medication adherence during laboratory workup for primary aldosteronism: pilot study.

Friederike A Sandbaumhüter1,2, Manuel Haschke1,2, Bruno Vogt3

  • 1Institute of Pharmacology, University of Bern, Bern, Switzerland, juergen.bohlender@insel.ch.

Patient Preference and Adherence
|December 5, 2018
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Summary

Patient nonadherence to medication guidelines is common during aldosteronism testing. This frequent issue necessitates cautious interpretation of biochemical test results and improved screening protocols.

Keywords:
adherencealdosteronedrughypertensionscreeningspectrometry

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Area of Science:

  • Endocrinology
  • Clinical Chemistry

Background:

  • Current hypertension guidelines recommend discontinuing incompatible medications before laboratory screening for aldosteronism.
  • Patient adherence to these medication cessation guidelines is not well-established.
  • Biochemical tests for aldosteronism may be subject to drug bias due to nonadherence.

Purpose of the Study:

  • To measure plasma drug concentrations to assess patient adherence to medication guidelines during aldosteronism screening.
  • To identify potential drug bias in biochemical tests resulting from medication nonadherence.

Main Methods:

  • Quantified plasma concentrations of 10 antihypertensive drugs using mass spectrometry in 24 patients with uncontrolled hypertension.
  • Collected plasma samples on two visits: before stopping medications and on the day of biochemical testing after stopping incompatible medications.
  • Defined same-day dose intake by plasma concentrations exceeding expected trough levels.

Main Results:

  • A significant proportion of patients (33%) exhibited nonadherence, with detected drug levels diverging from prescriptions.
  • On the day of testing, 21% of patients used medications incompatible with the biochemical tests.
  • Additional nonadherence was identified through plasma drug concentrations below expected trough levels, missed by qualitative tests.

Conclusions:

  • Frequent nonadherence among patients undergoing aldosteronism evaluation necessitates careful interpretation of laboratory results.
  • New screening protocols should be developed, incorporating patient incentives and adherence checks.
  • Multicenter studies are recommended to validate and refine these new screening approaches.