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Therapeutic Drug Monitoring in Arterial Hypertension

Sergey Seleznev1, Alexey Shchulkin2, Pavel Mylnikov2

  • 1Department of Hospital Therapy with a Course of Medical and Social Expertise, Ryazan State Medical University, Ryazan 390026, Russia.

Journal of Personalized Medicine
|May 27, 2023
PubMed

Insights

Antihypertensive drug (AHD) concentrations in patients with controlled and uncontrolled arterial hypertension (AH) showed no significant differences. Low drug levels were observed in some patients, suggesting adherence issues, not pharmacokinetics, may cause treatment failure.

Area of Science:

  • Pharmacology
  • Cardiology
  • Clinical Pharmacy

Background:

  • Arterial hypertension (AH) management requires consistent antihypertensive drug (AHD) efficacy.
  • Assessing AHD serum concentrations is crucial for understanding treatment effectiveness in controlled and uncontrolled AH.
  • Patient adherence to AHD therapy can significantly impact treatment outcomes.

Purpose of the Study:

  • To evaluate and compare the serum concentrations of common AHDs in patients with controlled versus uncontrolled arterial hypertension.
  • To investigate the relationship between AHD pharmacokinetics and treatment efficacy in hypertensive patients.
  • To determine if low AHD levels correlate with uncontrolled blood pressure.

Main Methods:

  • A study involving 46 patients with arterial hypertension, randomized into controlled and uncontrolled groups based on 24-hour ambulatory blood pressure monitoring (ABPM).
  • Measurement of serum concentrations of lisinopril, amlodipine, valsartan, and indapamide before and 2 hours after drug intake.
  • Analysis of drug concentrations in relation to blood pressure control status and therapeutic drug monitoring (TDM) principles.

Main Results:

  • No significant differences in median AHD concentrations (lisinopril, indapamide, amlodipine, valsartan) were found between patients with controlled and uncontrolled AH (p > 0.05).
  • A notable finding was the presence of AHD concentrations below the limit of quantification in some patients, irrespective of their blood pressure control status.
  • These low concentrations were observed in both controlled and, for the first time, uncontrolled AH groups.

Conclusions:

  • The pharmacokinetics of AHDs do not appear to be a primary factor in the ineffectiveness of AH therapy.
  • Observed low drug concentrations suggest that patient adherence to prescribed AHD regimens may be a more significant issue.
  • Therapeutic drug monitoring (TDM) is a valuable tool for assessing patient adherence and optimizing antihypertensive treatment strategies.

Keywords:
HPLC MS/MSantihypertensive drugsarterial hypertension

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