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Lane D, Alghamdi R, Muscat M, Kaur MS, Davis T, Cole R, Patel P, Tomaszewski M, Gupta P. 1424The diagnosis of non-adherence in hypertension using a urine biochemical screen is unaffected by drug pharmacokinetics. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Suboptimal drug adherence in hypertension is pandemic and traditional diagnostic tools to detect non-adherence have lacked accuracy and robustness. The inability to identify non-adherence has therefore driven the development of biochemical drug screening by liquid chromatography tandem mass spectrometry (LC- MS/MS) in urine and blood, which are the most accurate metrics presently available. Urinary antihypertensive testing is evidenced to improve non-adherence rates, significantly decrease blood pressure after physician intervention, and be cost effective. The European Society of Cardiology (ESC) and European Society of Hypertension (ESH) 2018 guidelines have recommended the use of biochemical testing for non-adherence diagnosis. However, it has been argued that the variable pharmacokinetic parameters of the medication (such as their half-lives and clearance rates) may affect the detection of medications in urine and hence the determination of adherence. We hypothesized that pharmacokinetic parameters do not affect the detection of antihypertensive medications in urine.
Aim
This study compared the pharmacokinetic parameters of the most commonly prescribed antihypertensive medications against their detection in urine by LC-MS/MS.
Methods
Results of urinary drug screens from 463 hypertensive patients (total prescribed medications N=1709) were collated. An adherence score termed as the C score (number of detected vs. prescribed medication) was generated for each of the 27 common antihypertensive medications. Pharmacokinetic parameters such as bioavailability, plasma concentration, volume of distribution, half-life, plasma clearance and urinary excretion values for each drug were obtained from published literature. Partial linear correlation was conducted between the C score of all the medications and each pharmacokinetic parameter studied.
Results
40% of patients were non-adherent. The average number of prescribed medications was high (N=3.7, SD: 1.5), and the average number of drugs detected was lower (N=2.5, SD: 1.6). Amlodipine was the most prescribed (N=224), and clonidine was the least (N=10). The half-lives ranged from 0.87 to 39 hours for bumetanide and amlodipine respectively. The urinary excretion percentage varied from <1% for nifedipine, and 94% for benfroflumethiazide. No significant correlation was found between any drug C score and their respective pharmacokinetic variables such as the medication half-lives (figure1).
Half-life versus adherence score
Conclusion
This study reports no significant correlation between drug pharmacokinetics and adherence. To the best of our knowledge this is the first study of its kind. Urinary biochemical testing by LC-MS/MS for non-adherence remains a valid tool for diagnosis although further detailed pharmacokinetic studies are needed to confirm this finding.
Acknowledgement/Funding
None
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Affiliation(s)
- D Lane
- University Hospitals of Leicester NHS Trust, Department of Chemical Pathology and Metabolic Medicine, Leicester, United Kingdom
| | - R Alghamdi
- University Hospitals of Leicester NHS Trust, Department of Chemical Pathology and Metabolic Medicine, Leicester, United Kingdom
| | - M Muscat
- University Hospitals of Leicester NHS Trust, Department of Chemical Pathology and Metabolic Medicine, Leicester, United Kingdom
| | - M S Kaur
- University Hospitals of Leicester NHS Trust, Department of Chemical Pathology and Metabolic Medicine, Leicester, United Kingdom
| | - T Davis
- University Hospitals of Leicester NHS Trust, Department of Chemical Pathology and Metabolic Medicine, Leicester, United Kingdom
| | - R Cole
- University Hospitals of Leicester NHS Trust, Department of Chemical Pathology and Metabolic Medicine, Leicester, United Kingdom
| | - P Patel
- University Hospitals of Leicester NHS Trust, Department of Chemical Pathology and Metabolic Medicine, Leicester, United Kingdom
| | - M Tomaszewski
- University of Manchester, Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester, United Kingdom
| | - P Gupta
- University Hospitals of Leicester NHS Trust, Department of Chemical Pathology and Metabolic Medicine, Leicester, United Kingdom
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Moghe GA, Kaur MS, Thomas AM, Raseswari T, Swapna M, Rao L. The role of 9qh+ in phenotypic and genotypic heterogeneity in a Van der Woude syndrome pedigree. J Indian Soc Pedod Prev Dent 2010; 28:104-9. [PMID: 20660977 DOI: 10.4103/0970-4388.66749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Van der Woude syndrome (VWS) (OMIM 119300) is a dominantly inherited developmental disorder that is characterized by pits and/or sinuses of the lower lip and cleft lip and/or cleft palate. Mutations in the interferon regulatory factor 6 gene (IRF6) have been recently identified in patients with VWS, with more than 60 mutations reported. We report the phenotypic variants of the syndrome in a family and present the application of the multicolor chromosome banding (mBAND) analysis in the identification of complex intrachromosome rearrangements of chromosome 9 in a child with VWS. The authors conclude that increased heterochromatin on chromosome 9 did not have any effect on the phenotypic expression of the syndrome in the family that was studied.
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Affiliation(s)
- G A Moghe
- Department of Pedodontics and Preventive Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Dilsukhnagar, Hyderabad, Andhra Pradesh, India.
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