TY - JOUR
T1 - Clinical characteristics do not reliably identify non-adherence in patients with uncontrolled hypertension
AU - Groenland, Eline H.
AU - Dasgupta, Indranil
AU - Visseren, Frank L.J.
AU - van der Elst, Kim C.M.
AU - Lorde, Nathan
AU - Lawson, Alexander J.
AU - Bots, Michiel L.
AU - Spiering, Wilko
N1 - Funding Information:
The authors gratefully acknowledge the contribution of C. Flint and J. Wierdsma for their support in the diagnostic work-up of patients with difficult-to-control hypertension in our clinic, A. Punt for the bioanalytical work and Dr. W. Pasma for the data management.
Publisher Copyright:
© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2022/7/27
Y1 - 2022/7/27
N2 - Purpose: Chemical adherence testing is a reliable method to assess adherence to antihypertensive drugs. However, it is expensive and has limited availability in clinical practice. To reduce the number and costs of chemical adherence tests, we aimed to develop and validate a clinical screening tool to identify patients with a low probability of non-adherence in patients with uncontrolled hypertension. Materials and Methods: In 495 patients with uncontrolled hypertension referred to the University Medical Centre Utrecht (UMCU), the Netherlands, a penalised logistic regression model including seven pre-specified easy-to-measure clinical variables was derived to estimate the probability of non-adherence. Non-adherence was defined as not detecting at least one of the prescribed antihypertensive drugs in plasma or urine. Model performance and test characteristics were evaluated in 240 patients with uncontrolled hypertension referred to the Heartlands Hospital, United Kingdom. Results: Prevalence of non-adherence to antihypertensive drugs was 19% in the UMCU and 44% in the Heartlands Hospital population. After recalibration of the model’s intercept, predicted probabilities agreed well with observed frequencies. The c-statistic of the model was 0.63 (95%CI 0.53–0.72). Predicted probability cut-off values of 15%–22.5% prevented testing in 5%–15% of the patients, carrying sensitivities between 97% (64–100) and 90% (80–95), and negative predictive values between 74% (10–99) and 70% (50–85). Conclusion: The combination of seven clinical variables is not sufficient to reliably discriminate adherent from non-adherent individuals to safely reduce the number of chemical adherence tests. This emphasises the complex nature of non-adherence behaviour and thus the need for objective chemical adherence tests in patients with uncontrolled hypertension.
AB - Purpose: Chemical adherence testing is a reliable method to assess adherence to antihypertensive drugs. However, it is expensive and has limited availability in clinical practice. To reduce the number and costs of chemical adherence tests, we aimed to develop and validate a clinical screening tool to identify patients with a low probability of non-adherence in patients with uncontrolled hypertension. Materials and Methods: In 495 patients with uncontrolled hypertension referred to the University Medical Centre Utrecht (UMCU), the Netherlands, a penalised logistic regression model including seven pre-specified easy-to-measure clinical variables was derived to estimate the probability of non-adherence. Non-adherence was defined as not detecting at least one of the prescribed antihypertensive drugs in plasma or urine. Model performance and test characteristics were evaluated in 240 patients with uncontrolled hypertension referred to the Heartlands Hospital, United Kingdom. Results: Prevalence of non-adherence to antihypertensive drugs was 19% in the UMCU and 44% in the Heartlands Hospital population. After recalibration of the model’s intercept, predicted probabilities agreed well with observed frequencies. The c-statistic of the model was 0.63 (95%CI 0.53–0.72). Predicted probability cut-off values of 15%–22.5% prevented testing in 5%–15% of the patients, carrying sensitivities between 97% (64–100) and 90% (80–95), and negative predictive values between 74% (10–99) and 70% (50–85). Conclusion: The combination of seven clinical variables is not sufficient to reliably discriminate adherent from non-adherent individuals to safely reduce the number of chemical adherence tests. This emphasises the complex nature of non-adherence behaviour and thus the need for objective chemical adherence tests in patients with uncontrolled hypertension.
KW - Antihypertensive Agents/therapeutic use
KW - Humans
KW - Hypertension/diagnosis
KW - Medication Adherence
KW - Predictive Value of Tests
UR - http://www.scopus.com/inward/record.url?scp=85135194607&partnerID=8YFLogxK
U2 - 10.1080/08037051.2022.2104215
DO - 10.1080/08037051.2022.2104215
M3 - Article
C2 - 35899383
AN - SCOPUS:85135194607
SN - 0803-7051
VL - 31
SP - 178
EP - 186
JO - Blood pressure
JF - Blood pressure
IS - 1
ER -