Non-adherence to Antihypertensives Revealed
Non-adherence to Antihypertensives Revealed
The clinical characteristics of hypertensive patients are shown in Table 2.
Overall, 25% patients were totally or partially non-adherent to antihypertensive treatment (total non-adherence 10.1%, partial non-adherence 14.9%) (Table 3). The average number of antihypertensive drugs detected on screening (median 2 (25%–75% IQR: 1–3)) was lower than the number of drugs prescribed and screened for (median 3 (25%–75% IQR: 2–4)) (Table 3). Across the three groups of patients, the highest percentage of total non-adherence with antihypertensive treatment was among those referred for renal denervation—almost one in four patients from this group had none of the prescribed medications detected in urine, that is, complete non-adherence (Table 3). The prevalence of complete non-adherence among new referrals to the clinic (Group A) and follow-up patients (Group B) were lower at 8.8% and 9.1% (Table 2). However, their overall non-adherence (complete and partial non-adherence) was calculated at 18.4% and 37.9% (Groups A and B, respectively).
After adjustment for age, sex, ethnicity and clinical category (new referrals, follow-up patients, referrals for renal denervation), clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as 24 h mean daytime DBP were higher in non-adherent (either partially or completely) than fully adherent patients (Table 4). These differences were even more striking when contrasting fully adherent against totally non-adherent patients (Table 4). There was a linear relationship between BP and both the numerical difference and the ratio in detected/prescribed medications—those with difference = 0 and ratio = 1 (all medications taken and detected) had the lowest clinic SBP, clinic DBP and 24 h mean daytime DBP (figure 1). As a general trend, DBP showed a stronger association with non-adherence to antihypertensive medications than SBP (Table 4, figure 1 and figure 2).
(Enlarge Image)
Figure 1.
Association between blood pressures and the numerical difference between detected and prescribed antihypertensive medications in all hypertensive patients. Point data are absolute blood pressure values recorded on either clinic or 24 h ambulatory monitoring, p value—adjusted (for age, sex, ethnicity and clinical category (new referrals, follow-up patients, referrals for renal denervation)) level of statistical significance for every unit change in blood pressure per unit change in the difference between detected and prescribed antihypertensive medications.
(Enlarge Image)
Figure 2.
Association between blood pressures and the numerical ratio of detected and prescribed antihypertensive medications in all hypertensive patients. Point data are absolute blood pressure values recorded on either clinic or 24 h ambulatory monitoring, p value—adjusted (for age, sex, ethnicity and clinical category (new referrals, follow-up patients, referrals for renal denervation)) level of statistical significance for every unit change in blood pressure per unit change in the ratio of detected and prescribed antihypertensive medications.
Results
The clinical characteristics of hypertensive patients are shown in Table 2.
Overall, 25% patients were totally or partially non-adherent to antihypertensive treatment (total non-adherence 10.1%, partial non-adherence 14.9%) (Table 3). The average number of antihypertensive drugs detected on screening (median 2 (25%–75% IQR: 1–3)) was lower than the number of drugs prescribed and screened for (median 3 (25%–75% IQR: 2–4)) (Table 3). Across the three groups of patients, the highest percentage of total non-adherence with antihypertensive treatment was among those referred for renal denervation—almost one in four patients from this group had none of the prescribed medications detected in urine, that is, complete non-adherence (Table 3). The prevalence of complete non-adherence among new referrals to the clinic (Group A) and follow-up patients (Group B) were lower at 8.8% and 9.1% (Table 2). However, their overall non-adherence (complete and partial non-adherence) was calculated at 18.4% and 37.9% (Groups A and B, respectively).
After adjustment for age, sex, ethnicity and clinical category (new referrals, follow-up patients, referrals for renal denervation), clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as 24 h mean daytime DBP were higher in non-adherent (either partially or completely) than fully adherent patients (Table 4). These differences were even more striking when contrasting fully adherent against totally non-adherent patients (Table 4). There was a linear relationship between BP and both the numerical difference and the ratio in detected/prescribed medications—those with difference = 0 and ratio = 1 (all medications taken and detected) had the lowest clinic SBP, clinic DBP and 24 h mean daytime DBP (figure 1). As a general trend, DBP showed a stronger association with non-adherence to antihypertensive medications than SBP (Table 4, figure 1 and figure 2).
(Enlarge Image)
Figure 1.
Association between blood pressures and the numerical difference between detected and prescribed antihypertensive medications in all hypertensive patients. Point data are absolute blood pressure values recorded on either clinic or 24 h ambulatory monitoring, p value—adjusted (for age, sex, ethnicity and clinical category (new referrals, follow-up patients, referrals for renal denervation)) level of statistical significance for every unit change in blood pressure per unit change in the difference between detected and prescribed antihypertensive medications.
(Enlarge Image)
Figure 2.
Association between blood pressures and the numerical ratio of detected and prescribed antihypertensive medications in all hypertensive patients. Point data are absolute blood pressure values recorded on either clinic or 24 h ambulatory monitoring, p value—adjusted (for age, sex, ethnicity and clinical category (new referrals, follow-up patients, referrals for renal denervation)) level of statistical significance for every unit change in blood pressure per unit change in the ratio of detected and prescribed antihypertensive medications.
