Anti-hypertensive drug monitoring
Improve patient outcomes through prescription adherence testing
Resistant hypertension, or blood pressure not at goal while a patient is taking three or more anti-hypertensive medications, can occur for several reasons. Prescription nonadherence, while a major cause of inadequate response to prescription treatment, can be wrongly interpreted as resistant hypertension.1
Traditional avenues to assess for prescription nonadherence are limited, relying mainly on patient adherence reporting or prescription refill data. Laboratory testing that detects prescription medications in urine is an objective means of determining if the medications have been taken, which can inform disease management.
Anti-hypertensive drug monitoring test menu
Anti-hypertensive drug monitoring
Conventional methods to determine prescription adherence rely on subjective reporting and/or costly, time-intensive tactics, such as direct witness of medication intake.2 These methods do not always accurately reflect actual prescription adherence. Laboratory analysis can be used to objectively detect prescription medications in the urine.
Our novel hypertension drug monitoring profile uses liquid chromatography-tandem mass spectrometry (LC-MS/MS) to detect levels of 16 commonly prescribed hypertension medications in the urine. This panel also includes five commonly available diuretics and can be used to determine if the patient has taken one of these medications the prior day.
Identifying whether certain medications are present or absent in the urine can inform caregivers regarding the most appropriate next steps for patients with apparent resistant hypertension. Clarity on treatment resistance versus nonadherence can also minimize the need for patient referral for specialist care, which may include costly investigations for secondary causes of hypertension.2
Key testing
Advantages
- Assesses whether a patient has taken a prescribed medication in the previous 24 hours.
- Provides a more direct method to assess whether a patient is taking a certain medication to aid in patient management.
- Detects five commonly available diuretics.
- Assists physicians in avoiding overprescription of additional medications and medication complications.
- Helps prevent costly and time-consuming directly observed therapy.
Included medications
- Amlodipine
- Atenolol
- Bumetanide
- Carvedilol
- Chlorthalidone
- Clonidine
- Furosemide
- Hydralazine
- Hydrochlorothiazide
- Labetalol
- Lisinopril
- Losartan
- Metoprolol
- 7a- Thiomethylspironolactone
- Terazosin
- Torsemide
Highlights
John Lieske, M.D., and Sandra Taler, M.D., explain how Mayo Clinic Laboratories' mass spectrometry assay helps evaluate patients for resistant hypertension. The test can detect antihypertensive medications in urine, providing evidence of whether patients are actually absorbing their medications or whether a new approach might be needed.
References
- Tomaszewski M, White C, Patel P, et al. High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis. Heart. 2014 Jun;100(11):855-61. doi:10.1136/heartjnl-2013-305063
- Bourque G, Vladimir Ilin J, Ruzicka M, Hundemer G, Shorr R, Hiremath S. Nonadherence Is Common in Patients With Apparent Resistant Hypertension: A Systematic Review and Meta-analysis, American Journal of Hypertension, Volume 36, Issue 7, July 2023, Pages 394–403, https://doi.org/10.1093/ajh/hpad013
- Gupta P, Patel P, Štrauch B, et al. Bioche–mical Screening for Nonadherence Is Associated With Blood Pressure Reduction and Improvement in Adherence. Hypertension. 2017 Nov;70(5):1042-1048. doi: 10.1161/HYPERTENSIONAHA.117.09631. Epub 2017 Aug 28. PMID: 28847892; PMCID: PMC5642335