Impact of drug adherence on blood pressure response to alcohol-mediated renal denervation

IF 2.3 4区医学 Q2 PERIPHERAL VASCULAR DISEASE

Blood Pressure Pub Date : 2022-05-16 DOI:10.1080/08037051.2022.2074367

A. Persu, F. Maes, S. Toennes, S. Ritscher, C. Georges, P. Wallemacq, Nicole Haratani, H. Parise, T. Fischell, L. Lauder, F. Mahfoud

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引用次数: 2

Abstract

Abstract Purpose While poor drug adherence is frequent in patients with resistant hypertension, detailed analyses of the impact of drug adherence on the success of renal denervation are scarce. We report drug adherence at baseline, changes in drug adherence, and the influence of these parameters on blood pressure changes at 6 and 12 months in patients treated with alcohol-mediated renal denervation as part of the Peregrine study. Materials and methods Urinary detection of antihypertensive drugs was performed using high-performance liquid chromatography-tandem mass spectrometry. Full adherence, partial adherence, and complete non-adherence were defined as 0, 1, or ≥2 drugs not detected, respectively. Results Renal denervation was performed in 45 patients with uncontrolled hypertension on ≥3 antihypertensive medications (62% men, age 55 ± 10 years). At baseline, the proportion of fully, partially, and non-adherent patients was 62% (n = 28), 16% (n = 7), and 22% (n = 10), respectively. At 6 months, adherence improved by 21% (n = 9), remained unchanged at 49% (n = 21), and worsened by 30% (n = 13). Mean 24-h systolic blood pressure decreased by 10 ± 13, 10 ± 4, and 14 ± 19 mmHg in fully, partially, and non-adherent patients (p = 0.77), and by 14 ± 14, 8 ± 11, and 14 ± 18 mmHg in patients who improved, maintained, or decreased adherence, respectively (p = 0.35). The results at 12 months were similar. Conclusion About 40% of patients with apparently treatment-resistant hypertension were not fully adherent at baseline, and adherence decreased further in 30%. Nevertheless, mean blood pressure changes after renal denervation were similar irrespective of drug adherence. Our results suggest that such patients may benefit from alcohol-mediated renal denervation, irrespective of drug adherence. These findings are hypothesis-generating and need to be confirmed in ongoing sham-controlled trials.

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药物依从性对酒精介导的肾去神经支配血压反应的影响

摘要目的虽然耐药性高血压患者药物依从性差是常见的，但很少详细分析药物依从性对肾去神经支配成功的影响。我们报告了基线时的药物依从性、药物依从性的变化，以及这些参数对6岁和12岁时血压变化的影响作为Peregrine研究的一部分，在接受酒精介导的肾去神经支配治疗的患者中观察了数月。材料与方法采用高效液相色谱-串联质谱法对尿中降压药物进行检测。完全依从性、部分依从性和完全不依从性分别定义为0、1或≥2种未检测到的药物。结果45例接受≥3种降压药物治疗的高血压失控患者（62%为男性，55岁）进行了肾去神经支配 ± 10 年）。在基线时，完全、部分和非粘连患者的比例为62%（n = 28）、16%（n = 7）和22%（n = 10）分别。在6 月，依从性提高了21%（n = 9），保持不变，为49%（n = 21），恶化30%（n = 13）。24小时平均收缩压下降10 ± 13、10 ± 4和14 ± 19 完全、部分和非粘连患者的mmHg（p = 0.77），到14 ± 14，8 ± 11和14 ± 18 mmHg在改善、维持或降低依从性的患者中的表达（p = 0.35）几个月的情况相似。结论约40%的明显耐药高血压患者在基线时没有完全粘附，30%的患者粘附力进一步下降。然而，无论药物依从性如何，肾去神经支配后的平均血压变化都是相似的。我们的研究结果表明，无论药物依从性如何，这些患者都可能受益于酒精介导的肾去神经支配。这些发现是假设产生的，需要在正在进行的假对照试验中得到证实。

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来源期刊

Blood Pressure 医学-外周血管病

CiteScore

3.00

自引率

5.60%

发文量

审稿时长

6-12 weeks

期刊介绍： For outstanding coverage of the latest advances in hypertension research, turn to Blood Pressure, a primary source for authoritative and timely information on all aspects of hypertension research and management. Features include: • Physiology and pathophysiology of blood pressure regulation • Primary and secondary hypertension • Cerebrovascular and cardiovascular complications of hypertension • Detection, treatment and follow-up of hypertension • Non pharmacological and pharmacological management • Large outcome trials in hypertension.