The Department of Chemical Pathology and Metabolic Diseases, Level 4, Sandringham Building, Leicester Royal Infirmary, United Kingdom (D.L., P.P., P.G.).
Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, United Kingdom (D.L., K.K.).
Hypertension. 2022 Jan;79(1):12-23. doi: 10.1161/HYPERTENSIONAHA.121.17596. Epub 2021 Nov 5.
Nonadherence to antihypertensive medication is common, especially in those with apparent treatment-resistant hypertension (true treatment-resistant hypertension requires exclusion of nonadherence), and its routine detection is supported by clinical guidelines. Chemical adherence testing is a reliable and valid method to detect adherence, yet methods are unstandardized and are not ubiquitous. This article describes the principles of chemical adherence testing for hypertensive patients and provides a set of recommendations for centers wishing to develop the test. We recommend testing should be done in either of two instances: (1) in those who have resistant hypertension or (2) in those on 2 antihypertensives who have a less than 10 mm Hg drop in systolic blood pressure on addition of the second antihypertensive medication. Furthermore, we recommend that verbal consent is secured before undertaking the test, and the results should be discussed with the patient. Based on medications prescribed in United Kingdom, European Union, and United States, we list top 20 to 24 drugs that cover >95% of hypertension prescriptions which may be included in the testing panel. Information required to identify these medications on mass spectrometry platforms is likewise provided. We discuss issues related to ethics, sample collection, transport, stability, urine versus blood samples, qualitative versus quantitative testing, pharmacokinetics, instrumentation, validation, quality assurance, and gaps in knowledge. We consider how to best present, interpret, and discuss chemical adherence test results with the patient. In summary, this guidance should help clinicians and their laboratories in the development of chemical adherence testing of prescribed antihypertensive drugs.
抗高血压药物治疗不依从是很常见的，尤其是在那些明显治疗抵抗性高血压（真正的治疗抵抗性高血压需要排除不依从性）的患者中，临床指南支持常规检测不依从性。化学药物依从性检测是一种可靠和有效的方法来检测依从性，但方法不规范，也不普遍。本文描述了高血压患者化学药物依从性检测的原则，并为希望开发该检测的中心提供了一套建议。我们建议在以下两种情况下进行检测：（1）在那些有抵抗性高血压的患者中；（2）在那些已经服用了两种降压药物，但在加用第二种降压药物后收缩压下降不到 10mmHg 的患者中。此外，我们建议在进行检测前获得口头同意，并与患者讨论检测结果。根据英国、欧盟和美国的处方药物，我们列出了可能包含在检测面板中的前 20 到 24 种覆盖>95%高血压处方的药物。同样提供了在质谱平台上识别这些药物所需的信息。我们讨论了与伦理、样本采集、运输、稳定性、尿液与血液样本、定性与定量检测、药代动力学、仪器、验证、质量保证以及知识空白相关的问题。我们考虑如何最好地向患者呈现、解释和讨论化学药物依从性检测结果。总之，本指南应有助于临床医生及其实验室开发处方抗高血压药物的化学药物依从性检测。
