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Assessment of Anti-Hypertensive Drug Adherence by Serial Aldosterone-To-Renin Ratio Measurement
Reduced or absent compliance to anti-hypertensive treatment is a major obstacle to the achievement of blood pressure target in patients with arterial hypertension. Current available methods for therapeutic adherence assessment display low accuracy, limited applicability in clinical practice and/or h...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141919/ https://www.ncbi.nlm.nih.gov/pubmed/34040531 http://dx.doi.org/10.3389/fphar.2021.668843 |
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author | Buffolo, Fabrizio Sconfienza, Elisa Burrello, Jacopo Losano, Isabel Mengozzi, Giulio Priolo, Gabriella Avataneo, Valeria D’Avolio, Antonio Veglio, Franco Rabbia, Franco Mulatero, Paolo Monticone, Silvia |
author_facet | Buffolo, Fabrizio Sconfienza, Elisa Burrello, Jacopo Losano, Isabel Mengozzi, Giulio Priolo, Gabriella Avataneo, Valeria D’Avolio, Antonio Veglio, Franco Rabbia, Franco Mulatero, Paolo Monticone, Silvia |
author_sort | Buffolo, Fabrizio |
collection | PubMed |
description | Reduced or absent compliance to anti-hypertensive treatment is a major obstacle to the achievement of blood pressure target in patients with arterial hypertension. Current available methods for therapeutic adherence assessment display low accuracy, limited applicability in clinical practice and/or high costs. We designed a prospective study to evaluate the accuracy of serial measurement of ARR to assess the therapeutic compliance to RAAS inhibitors. We prospectively enrolled 80 subjects: 40 patients with arterial hypertension and 40 normotensive controls. The ARR was evaluated at baseline and 2 and 8 week after initiation of a RAAS inhibitor in patients with hypertension, and at baseline and 2 weeks for the control group. Adherence to the prescribed therapy was confirmed by therapeutic drug monitoring. We observed a significant increase of renin levels and reduction of aldosterone levels after RAAS inhibitors initiation, with consequent reduction of ARR. Delta ARR (ΔARR), defined as relative change in ARR before and after treatment initiation, provided high accuracy for determination of therapeutic compliance, with an AUC of 0.900 at 2 weeks and 0.886 at 8 weeks. A cut-off of −48% of ΔARR provided 90% sensitivity and 75% specificity, at 2 and 8 weeks. In conclusion, the measurement of ΔARR is a powerful test, cheap and widely available to accurately identify the non-adherence to RAAS inhibitors treatment. Herein we propose the implementation of ΔARR in clinical practice through a multi-step flow-chart for the management of patients with uncontrolled blood pressure, with identification of those suspected of non-adherence, reserving therapeutic drug monitoring for non-adherence confirmation. |
format | Online Article Text |
id | pubmed-8141919 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-81419192021-05-25 Assessment of Anti-Hypertensive Drug Adherence by Serial Aldosterone-To-Renin Ratio Measurement Buffolo, Fabrizio Sconfienza, Elisa Burrello, Jacopo Losano, Isabel Mengozzi, Giulio Priolo, Gabriella Avataneo, Valeria D’Avolio, Antonio Veglio, Franco Rabbia, Franco Mulatero, Paolo Monticone, Silvia Front Pharmacol Pharmacology Reduced or absent compliance to anti-hypertensive treatment is a major obstacle to the achievement of blood pressure target in patients with arterial hypertension. Current available methods for therapeutic adherence assessment display low accuracy, limited applicability in clinical practice and/or high costs. We designed a prospective study to evaluate the accuracy of serial measurement of ARR to assess the therapeutic compliance to RAAS inhibitors. We prospectively enrolled 80 subjects: 40 patients with arterial hypertension and 40 normotensive controls. The ARR was evaluated at baseline and 2 and 8 week after initiation of a RAAS inhibitor in patients with hypertension, and at baseline and 2 weeks for the control group. Adherence to the prescribed therapy was confirmed by therapeutic drug monitoring. We observed a significant increase of renin levels and reduction of aldosterone levels after RAAS inhibitors initiation, with consequent reduction of ARR. Delta ARR (ΔARR), defined as relative change in ARR before and after treatment initiation, provided high accuracy for determination of therapeutic compliance, with an AUC of 0.900 at 2 weeks and 0.886 at 8 weeks. A cut-off of −48% of ΔARR provided 90% sensitivity and 75% specificity, at 2 and 8 weeks. In conclusion, the measurement of ΔARR is a powerful test, cheap and widely available to accurately identify the non-adherence to RAAS inhibitors treatment. Herein we propose the implementation of ΔARR in clinical practice through a multi-step flow-chart for the management of patients with uncontrolled blood pressure, with identification of those suspected of non-adherence, reserving therapeutic drug monitoring for non-adherence confirmation. Frontiers Media S.A. 2021-05-10 /pmc/articles/PMC8141919/ /pubmed/34040531 http://dx.doi.org/10.3389/fphar.2021.668843 Text en Copyright © 2021 Buffolo, Sconfienza, Burrello, Losano, Mengozzi, Priolo, Avataneo, D’Avolio, Veglio, Rabbia, Mulatero and Monticone. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pharmacology Buffolo, Fabrizio Sconfienza, Elisa Burrello, Jacopo Losano, Isabel Mengozzi, Giulio Priolo, Gabriella Avataneo, Valeria D’Avolio, Antonio Veglio, Franco Rabbia, Franco Mulatero, Paolo Monticone, Silvia Assessment of Anti-Hypertensive Drug Adherence by Serial Aldosterone-To-Renin Ratio Measurement |
title | Assessment of Anti-Hypertensive Drug Adherence by Serial Aldosterone-To-Renin Ratio Measurement |
title_full | Assessment of Anti-Hypertensive Drug Adherence by Serial Aldosterone-To-Renin Ratio Measurement |
title_fullStr | Assessment of Anti-Hypertensive Drug Adherence by Serial Aldosterone-To-Renin Ratio Measurement |
title_full_unstemmed | Assessment of Anti-Hypertensive Drug Adherence by Serial Aldosterone-To-Renin Ratio Measurement |
title_short | Assessment of Anti-Hypertensive Drug Adherence by Serial Aldosterone-To-Renin Ratio Measurement |
title_sort | assessment of anti-hypertensive drug adherence by serial aldosterone-to-renin ratio measurement |
topic | Pharmacology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141919/ https://www.ncbi.nlm.nih.gov/pubmed/34040531 http://dx.doi.org/10.3389/fphar.2021.668843 |
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