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Clinical characteristics do not reliably identify non-adherence in patients with uncontrolled hypertension
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Groenland, Eline H., Dasgupta, Indranil, Visseren, Frank L. J., van der Elst, Kim C. M., Lorde, Nathan, Lawson, Alexander J., Bots, Michiel L. and Spiering, Wilko (2022) Clinical characteristics do not reliably identify non-adherence in patients with uncontrolled hypertension. Blood Pressure, 31 (1). pp. 178-186. doi:10.1080/08037051.2022.2104215 ISSN 0803-7051.
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WRAP-Clinical-characteristics-reliably-identify-non-adherence-hypertension-22.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons: Attribution-Noncommercial 4.0. Download (1286Kb) | Preview |
Official URL: http://dx.doi.org/10.1080/08037051.2022.2104215
Abstract
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.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||
| Journal or Publication Title: | Blood Pressure | ||||
| Publisher: | Routledge | ||||
| ISSN: | 0803-7051 | ||||
| Official Date: | 27 July 2022 | ||||
| Dates: |
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| Volume: | 31 | ||||
| Number: | 1 | ||||
| Page Range: | pp. 178-186 | ||||
| DOI: | 10.1080/08037051.2022.2104215 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||
| Date of first compliant deposit: | 18 August 2022 | ||||
| Date of first compliant Open Access: | 18 August 2022 |
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