Strauch Branislav, Petrák Ondřej, Zelinka Tomáš, Rosa Ján, Somlóová Zuzana, Indra Tomáš, Chytil Lukáš, Marešová Věra, Kurcová Ivana, Holaj Robert, Wichterle Dan, Widimský Jiří
a3rd Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Center bInstitute of Forensic Medicine and Toxicology, Toxicology Laboratory, General University Hospital, 1st Faculty of Medicine, Charles University, Prague cInstitute for Clinical and Experimental Medicine, Prague d2nd Department of Medicine, General University Hospital, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
J Hypertens. 2013 Dec;31(12):2455-61. doi: 10.1097/HJH.0b013e3283652c61.
The aim of our study was to assess the prevalence of pseudo-resistance caused by noncompliance with treatment among patients with severe resistant hypertension and to analyze the contributing factors.
Three hundred and thirty-nine patients (195 men) with resistant essential hypertension were studied. The first group consisted of 176 patients admitted for hospitalization for exclusion of a secondary cause to our hypertension centre (103 men); the second one consisted of 163 out-patients (92 men) investigated for the first time in an out-patient hypertension clinic. Unplanned blood sampling for assessment of serum antihypertensive drug concentrations by means of liquid chromatography-mass spectrometry was performed in all patients.
Our main finding is a surprisingly low compliance with drug treatment in out-patients with resistant hypertension (23% partially noncompliant and 24% totally noncompliant - in total, 47% prevalence of noncompliance). Eighty-one percent of hospitalized patients were positive, in 10% the results were partially positive and in 9% of the patients, the drugs were all negative. The compliance among hospitalized patients was probably better due to lower numbers of prescribed drugs and expected thorough investigation. More frequently, noncompliance was found in nonworking (potential purpose-built behaviour), younger and less well educated patients. The most frequent noncompliance was to doxazosine, spironolactone and hydrochlorothiazide. We have observed a surprisingly low compliance with treatment among out-patients with severe hypertension.
We conclude that the evaluation of antihypertensive drugs concentrations is a useful and precise method for assessment of noncompliance in patients with resistant hypertension. This evaluation is useful before starting the diagnostic work-up of secondary forms of hypertension and before assignment patients into protocols with new therapy modalities such as renal denervation.
我们研究的目的是评估重度顽固性高血压患者中因治疗依从性不佳导致的假性耐药的患病率，并分析相关影响因素。
对339例（195例男性）原发性顽固性高血压患者进行了研究。第一组由176例因排除继发性病因入住我们高血压中心的患者组成（103例男性）；第二组由163例首次在门诊高血压诊所接受检查的门诊患者组成（92例男性）。对所有患者进行了计划外采血，通过液相色谱 - 质谱法评估血清抗高血压药物浓度。
我们的主要发现是，顽固性高血压门诊患者的药物治疗依从性低得出奇（23%部分不依从，24%完全不依从——总计不依从患病率为47%）。81%的住院患者检测结果呈阳性，10%的结果部分呈阳性，9%的患者药物检测均为阴性。住院患者的依从性可能更好，这是因为所开药物数量较少且预期检查更全面。更常见的情况是，在无工作（可能是故意行为）、年轻且受教育程度较低的患者中发现不依从情况。最常出现不依从的药物是多沙唑嗪、螺内酯和氢氯噻嗪。我们观察到重度高血压门诊患者的治疗依从性低得出奇。
我们得出结论，评估抗高血压药物浓度是评估顽固性高血压患者不依从情况的一种有用且精确的方法。这种评估在开始继发性高血压的诊断检查之前以及在将患者分配到肾去神经支配等新治疗模式的方案之前是有用的。
