Masked Uncontrolled Hypertension Is Not Attributable to Medication Nonadherence

Area of Science:

• Cardiology
• Clinical Pharmacology
• Hypertension Management

Background:

• Masked uncontrolled hypertension (MUCH) is defined by controlled office blood pressure (BP) but uncontrolled out-of-clinic BP.
• Understanding the causes of MUCH is crucial for effective hypertension management.
• Antihypertensive medication nonadherence is a potential, yet unconfirmed, contributor to MUCH.

Purpose of the Study:

• To investigate whether masked uncontrolled hypertension (MUCH) in treated patients is attributable to antihypertensive medication nonadherence.
• To compare medication adherence levels between patients with MUCH and those with true controlled hypertension.

Main Methods:

• Ambulatory BP monitoring was used to identify patients with MUCH (controlled office BP, uncontrolled out-of-clinic BP).
• Urinary drug and metabolite levels were measured using high-performance liquid chromatography-tandem mass spectrometry to assess medication adherence.
• Adherence was categorized as fully adherent or partially adherent based on detected medications.

Main Results:

• A high rate of antihypertensive medication adherence was found in both the MUCH group (85.2% fully adherent) and the true controlled hypertension group (89.6% fully adherent).
• No statistically significant difference in adherence rates was observed between the MUCH and true controlled hypertension groups (P=0.403).
• No patients in either group were found to be fully nonadherent to their prescribed medications.

Conclusions:

• Masked uncontrolled hypertension (MUCH) is not attributable to antihypertensive medication nonadherence in treated patients.
• High medication adherence is prevalent in both MUCH and truly controlled hypertension, suggesting other underlying factors contribute to MUCH.
• These findings necessitate further research into the causes and management strategies for masked uncontrolled hypertension.