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Nonadherence in Hypertension: How to Develop and Implement Chemical Adherence Testing.
Dan Lane1,2, Alexander Lawson3, Angela Burns4
1The Department of Chemical Pathology and Metabolic Diseases, Level 4, Sandringham Building, Leicester Royal Infirmary, United Kingdom (D.L., P.P., P.G.).
Hypertension (Dallas, Tex. : 1979)
|November 5, 2021
Summary
Chemical adherence testing reliably detects nonadherence to antihypertensive medication. This guidance offers recommendations for developing and implementing this crucial test for hypertension management.
Area of Science:
- Pharmacology
- Clinical Chemistry
- Hypertension Management
Background:
- Nonadherence to antihypertensive medication is prevalent, particularly in apparent treatment-resistant hypertension.
- Routine detection of nonadherence is recommended by clinical guidelines.
- Current chemical adherence testing methods lack standardization and widespread adoption.
Purpose of the Study:
- To describe the principles of chemical adherence testing for hypertensive patients.
- To provide recommendations for developing and implementing chemical adherence testing.
- To standardize the approach to detecting medication nonadherence in hypertension.
Main Methods:
- Review of principles for chemical adherence testing.
- Development of recommendations for test implementation based on clinical scenarios.
- Identification of key antihypertensive drugs for testing panels.
- Discussion of technical, ethical, and practical considerations for testing.
Main Results:
- Recommendations for when to perform chemical adherence testing: in resistant hypertension or suboptimal response to dual therapy.
- A list of top antihypertensive drugs covering >95% of prescriptions is provided.
- Information for mass spectrometry identification of these drugs is included.
Conclusions:
- Chemical adherence testing is a valid method for detecting nonadherence in hypertension.
- Standardized guidelines are needed to facilitate the development and implementation of these tests.
- This guidance aims to assist clinicians and laboratories in establishing chemical adherence testing programs.
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