P1.11 TRUE ANTIHYPERTENSIVE EFFICACY OF SEQUENTIAL NEPHRON BLOCKADE IN PATIENTS WITH RESISTANT HYPERTENSION AND CONFIRMED MEDICATION ADHERENCE

DOI

10.1016/j.artres.2013.10.042How to use a DOI?

Abstract

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.

Open Access

This is an open access article distributed under the CC BY-NC license.

Download article (PDF)
View full text (HTML)

TY  - JOUR
AU  - H.B. Beaussier
AU  - F.M. Michael
AU  - F.C. Coudore
AU  - M.B. Briet
AU  - S.P. Peyrard
AU  - M.A. Azizi
AU  - P.F.P. Plouin
AU  - S.L. Laurent
AU  - P.B. Boutouyrie
AU  - G.B. Bobrie
PY  - 2013
DA  - 2013/11/11
TI  - P1.11 TRUE ANTIHYPERTENSIVE EFFICACY OF SEQUENTIAL NEPHRON BLOCKADE IN PATIENTS WITH RESISTANT HYPERTENSION AND CONFIRMED MEDICATION ADHERENCE
JO  - Artery Research
SP  - 113
EP  - 114
VL  - 7
IS  - 3-4
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2013.10.042
DO  - 10.1016/j.artres.2013.10.042
ID  - Beaussier2013
ER  -