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Urine testing increases patient adherence to hypertension drugs

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Using a urine test to check drug adherence among patients who have been struggling to regularly take their anti-hypertensives, with a resultant drop in blood pressure, according to UK researchers.

Over 50% of patients who underwent the urine test became completely adherent to their prescribed blood pressure lowering treatment and a further 30% of patients improved their adherence.

“The blood pressure drop we see as a result of this test being used in clinical practice is likely to save lives”

Maciej Tomaszewski

The researchers said that such a significant drop in blood pressure may translate into an around 45% reduction in risk of coronary heart disease and a 65% reduction in the risk of stroke.

Of the 238 patients who underwent the urine test, 73 were not taking their blood pressure lowering tablets on a regular basis, said the researchers.

The same team had previously suggested that more than one third of patients with hypertension were not been taking their blood pressure medication as prescribed.

They tracked blood pressure changes in the 73 patients who had struggled to take their tablets regularly following an appointment during which their initial urine test was discussed.

“These techniques for monitoring treatment should be more widely available on the NHS to improve patient outcomes”

Bryan Williams

The researchers said they noticed that systolic blood pressure fell on average by between 20-30mmHg between the urine test and the final clinic visit.

The most common reason for non-intentional non-adherence was from patients forgetting to take the drugs, because so many of them were prescribed, noted the study authors.

The testing was done using liquid chromatography-tandem mass spectrometry-based biochemical analysis.

The research, published in the journal Hypertension, was conducted by a team from the universities of Manchester, Leicester, University College London and Prague in the Czech Republic.

It also included collaboration with Central Manchester University Hospitals NHS Foundation Trust and University Hospitals of Leicester NHS Trust.

Lead study author Dr Pankaj Gupta, from Leicester, said: “High blood pressure is the single most important risk factor for premature death internationally.

“Conversion of the majority of non-adherent hypertensive patients to adherence with a significant drop in blood pressure is an important breakthrough, given that previous studies showed limited benefits from complex and costly interventions,” he said.

University of Leicester

Urine testing increases patient adherence to hypertension drugs

Pankaj Gupta

Study co-author Dr Prashanth Patel said: “We suggest that repeated urine should be considered as a potential therapeutic approach to non-adherence in patients with high blood pressure.”

Meanwhile, Professor Maciej Tomaszewski, representing Manchester University in the study, said: “Our study shows the therapeutic benefits of biochemical screening for non-adherence to anti-hypertensive treatment.

“The blood pressure drop we see as a result of this test being used in clinical practice is likely to save lives,” he said. “It is also likely to have an important impact on health economy if used routinely.”

Professor Bryan Williams, chair of the European Society of Cardiology Council on Hypertension, said: “This research is important because it shows that patients taking multiple blood pressure pills are often failing to take all of their medications.”

He said: “The research shows that identifying this problem can lead to better adherence to treatment and better blood pressure control and will reduce the risk of these patients.

“These techniques for monitoring treatment should be more widely available on the NHS to improve patient outcomes,” he added.

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