| Summary: | Objective: We previously showed that sequential-nephron blockade (SNB) was more effective than combined renin angiotensin system blockade (RB) for controlling BP in patients with resistant hypertension (RH). We assessed medication adherence (MA) on the antihypertensive (AHT) response to SNB/RB with a new combined scoring system.
Design and method: Pts with daytime ambulatory SBP/DBP (dASBP/dADBP) ≥135 and/or 85 mmHg, despite 4 week with irbesartan (Irb)+HCTZ+amlodipine, were randomised to SNB (n=82) or RB (n=82) for 12 weeks. MA was scored as: (i) plasma Irb concentration; (ii) urinary AcSDKP/creatinine ratio (UR); (iii) last medication intake before visit (LMI); and (iv) pill counting (PC, %). 1 point of MA score was attributed to Irb >20ng/ml, UR >4nmol/mmol, LMI <24h, PC >80%. MA was defined as low (LMA, score ≤2), intermediate (IMA, score=3), and optimal (OMA, score=4).
Results: Among 164 pts: 82 had OMA (46 SNB/36 RB), 52 IMA (23 SNB/29 RB) and 30 LMA (13 SNB/17 RB) (NS). LMA pts were younger than SMA pts (50±11 vs. 56±10 yrs, p<0.011). In OMA pts, the difference in dASBP/dADBP between SNB vs RB was significant (−11 [−17 ;−6]/−6 [−9 ;−2] mmHg, p<0.0001/p=0.0025), favoring SNB, whereas in LMA pts the difference between the two groups did not reach significance (−6 [−19 ;7]/−1 [−10 ;7] mmHg, p=0.352/p=0.7096).
Conclusion: MA has a major effect on BP lowering, differences between SNB and RB being observed in pts with OMA, not in patients with LMA. Combined methods for assessing MA allow determining the true efficacy of AHT strategies in RH pts.
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