评估爱尔兰初级保健中明显治疗抵抗性高血压患者的治疗依从性：一项可行性研究。
Measuring adherence to therapy in apparent treatment-resistant hypertension: a feasibility study in Irish primary care.
机构信息
Graduate Entry Medical School, University of Limerick, Limerick; Discipline of General Practice, National University of Ireland (NUI) Galway, Galway, Ireland.
Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
出版信息
Br J Gen Pract. 2019 Aug 29;69(686):e621-e628. doi: 10.3399/bjgp19X705077. Print 2019 Sep.
BACKGROUND
Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled blood pressure (BP) in patients taking three or more antihypertensive medications. Some patients will have true treatment-resistant hypertension, some undiagnosed secondary hypertension, while others have pseudo-resistance. Pseudo-resistance occurs when non-adherence to medication, white-coat hypertension (WCH), lifestyle, and inadequate drug dosing are responsible for the poorly controlled BP.
AIM
To examine the feasibility of establishing non-adherence to medication, for the first time in primary care, using mass spectrometry urine analysis. Operationalisation would be established by at least 50% of patients participating and 95% of samples being suitable for analysis. Clinical importance would be confirmed by >10% of patients being non-adherent.
DESIGN AND SETTING
Eligible patients with aTRH ( = 453) in 15 university research-affiliated Irish general practices were invited to participate.
METHOD
Participants underwent mass spectrometry urine analysis to test adherence and ambulatory BP monitoring (ABPM) to examine WCH.
RESULTS
Of the eligible patients invited, 52% ( = 235) participated. All 235 urine samples (100%) were suitable for analysis: 174 (74%) patients were fully adherent, 56 (24%) partially adherent, and five (2%) fully non-adherent to therapy. A total of 206 patients also had ABPM, and in total 92 (45%) were categorised as pseudo-resistant. No significant associations were found between adherence status and patient characteristics or drug class.
CONCLUSION
In patients with aTRH, the authors have established that it is feasible to examine non-adherence to medications using mass spectrometry urine analysis. One in four patients were found to be partially or fully non-adherent. Further research on how to incorporate this approach into individual patient consultations and its associated cost-effectiveness is now appropriate.
背景
显效治疗抵抗性高血压（aTRH）定义为服用三种或更多种降压药物的患者血压控制不佳。一些患者存在真正的治疗抵抗性高血压，一些存在未确诊的继发性高血压，而另一些则存在假性抵抗。假性抵抗是由于药物不依从、白大衣高血压（WCH）、生活方式和药物剂量不足导致血压控制不佳引起的。
目的
首次在初级保健中使用质谱尿液分析来检测药物不依从性。通过至少 50%的患者参与和 95%的样本适合分析来确定操作定义。通过 >10%的患者不依从来确认临床重要性。
设计和设置
邀请 15 家爱尔兰大学附属医院的研究相关的具有 aTRH 的合格患者参与研究。
方法
参与者接受质谱尿液分析以测试依从性和动态血压监测（ABPM）以检查 WCH。
结果
在受邀的合格患者中，52%（=235）参与了研究。所有 235 个尿液样本（100%）均适合分析：174 名（74%）患者完全依从，56 名（24%）部分依从，5 名（2%）完全不依从治疗。共有 206 名患者还进行了 ABPM，其中共有 92 名（45%）被归类为假性抵抗。依从状态与患者特征或药物类别之间没有显著关联。
结论
在 aTRH 患者中，作者已经证实使用质谱尿液分析检测药物不依从性是可行的。四分之一的患者存在部分或完全不依从。现在适当进一步研究如何将这种方法纳入患者的个体咨询以及其相关的成本效益。
Zotero 插件