Is there any Hope for Monitoring Adherence in an Efficient and Feasible Way for Resistant Hypertension Diagnosis and Fol
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RESISTANT HYPERTENSION (L DRAGER, SECTION EDITOR)
Is there any Hope for Monitoring Adherence in an Efficient and Feasible Way for Resistant Hypertension Diagnosis and Follow-Up? Benjamin Kably 1,2,3 & Eliane M. Billaud 2,3 & Pierre Boutouyrie 1,2,3 & Michel Azizi 1,4,5 Accepted: 8 September 2020 / Published online: 14 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Non-adherence to antihypertensive treatment is highly prevalent and represents a major factor affecting their effectiveness in hypertensive patients, thus contributing to apparent treatment resistance. It is however often overlooked because the methods to assess non-adherence are mainly subjective, limiting their usefulness in clinical practice. Non-adherence to treatment affects daily patient management, resulting in inappropriate, costly, and potentially harmful treatments and loss of the expected benefits from antihypertensive drugs. Recent Findings Specialized centers now use a combination of objective screening tools. Firstly, snapshots of adherence levels can be provided by analytical drug detection in various biological matrixes using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and secondly electronic monitoring systems of drug delivery which provide longitudinal data on adherence. Routine utilization of those tools allows the detection of non-adherence in patients with resistant hypertension, thus enabling implementation of appropriate interventions to improve drug adherence and avoid unnecessary treatment intensification. Other complementary techniques, such as digital health feedback system with ingestible sensors, are currently evaluated. Summary In the context of an increasing burden of uncontrolled and apparent treatment-resistant hypertension, detecting nonadherence to antihypertensive therapy is, as acknowledged by the latest guidelines, a top priority to implement in clinical practice but still faces medical conservatism and disbelief. Keywords Resistant hypertension . Antihypertensive drugs . Drug adherence . Therapeutic drug monitoring . Electronic monitoring . Liquid chromatography-tandem mass spectrometry
Introduction Hypertension (HTN) remains poorly controlled worldwide, and its incidence is increasing, due to the aging of the This article is part of the Topical Collection on Resistant Hypertension * Michel Azizi [email protected] 1
Université de Paris, F-75006 Paris, France
2
Pharmacology Unit, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
3
Inserm U970, Paris Centre de Recherche Cardiovasculaire-PARCC, F-75015 Paris, France
4
Hypertension Unit, DMU CARTE, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
5
Inserm, CIC 1418, F-75015 Paris, France
population and the obesity epidemic [1, 2]. Among the reasons for uncontrolled hypertension, one can list lack of appropriate medical treatment (cost, availability, lack of proper measurements), therapeutic inertia (reluctance to intensify treatment), and lack of persi
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