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Quarter of hypertensive patients not taking meds.

Urine testing of patients with hypertension revealed that 25% were partially or totally nonadherent to treatment, researchers reported.

Furthermore, nonadherence was linearly related to increased systolic and diastolic blood pressure during clinic visits and 24-hour mean day-time diastolic blood pressure (P< .006 for all), reported Dr. Maciej Tomaszewski of the University of Leicester, England, and his associates.

Using a urine test available to commercial labs, they tested 208 patients for 40 of the most common antihypertensive medications and their metabolites by performing high-performance liquid chromatography-tandem mass spectrometry.

Patients were either newly referred, followed up for inadequately controlled blood pressure, or referred for renal denervation, they reported (Heart 2014 April 3 [doi: 10.1136/heartjnl-2013-305063]).

Nonadherence was particularly common among patients whose hypertension was inadequately controlled (28.8%) or who were referred for renal denervation (23.5%), the investigators said.

Without routine urine screening, nonadherent patients might receive or undergo unnecessary tests, procedures, or treatments for perceived nonresponse to treatment, added Dr. Tomaszewski, who is also with the National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Disease, and his colleagues.

Dr. Tomaszewski and five of his associates reported receiving research and other support from the British Heart Foundation and the National Institute for Health Research


Is the test ethical? Is overtreatment?

The authors "deftly sidestepped" questions related to the ethics of the test and what to do about the findings, said Dr. Morris J. Brown. "Neither completion nor assent to urine testing could be compulsory," he emphasized. "But then, nor is progression to expensive tests for benign, curable causes of resistant hypertension - without resistance to treatment being first demonstrated."

Dr. Brown is professor of clinical pharmacology at the University of Cambridge, England. He reported that he had no conflicts of interest. These remarks were taken from an accompanying editorial (Heart 2014 April 3 [doi: 10.1136/heartjnl-2013-305063]).
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Title Annotation:CARDIOLOGY
Author:Karon, Amy
Publication:Internal Medicine News
Date:Apr 15, 2014
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