Affiliation:
1. Klinik für Innere Medizin III Kardiologie, Angiologie und Internistische Intensivmedizin Universitätsklinikum des Saarlandes and Saarland University Homburg/Saar Germany
2. Department of Experimental and Clinical Toxicology Institute of Experimental and Clinical Pharmacology and Toxicology Center for Molecular Signaling Saarland University Homburg/Saar Germany
3. Institute for Medical Engineering and Science MIT Cambridge MA
Abstract
Background
It is currently unknown if antihypertensive drugs can be monitored in oral fluid (
OF
) using liquid chromatography coupled to high‐resolution mass spectrometry.
Methods and Results
We assessed adherence using liquid chromatography coupled to high‐resolution mass spectrometry in
OF
, plasma, and urine of 56 consecutive patients with hypertension referred to a tertiary hypertension unit. Of these patients, 59% were completely adherent (all drugs detectable in urine), whereas 29% and 13% were partially adherent (1 drug not detectable in urine) or nonadherent (>1 drug not detectable in urine), respectively. Adherent patients were on fewer antihypertensive drugs (
P
=0.001), had fewer daily drug doses (
P
=0.012), and had lower 24‐hour ambulatory systolic (
P
=0.012) and diastolic (
P
=0.009) blood pressures than nonadherent or partially adherent patients. Most drugs were detected in urine compared with plasma and
OF
(181 versus 119 versus 88;
P
=0.001). Compared with urine and plasma, detection rates of angiotensin‐converting enzyme inhibitors, angiotensin
II
receptor blockers, and diuretics were lower in
OF
. There was no difference in the frequency of detecting β blockers (
P
=1.0) and calcium channel blockers (
P
=0.063) when comparing
OF
with urine. There was no difference in the number of calcium channel blockers (
P
=0.727), β blockers (
P
=1.000), thiazide diuretics (
P
=0.125), and α‐2 agonists (
P
=0.125) identified between
OF
and plasma.
Conclusions
This study shows the feasibility of drug adherence testing for several antihypertensive drugs, especially those without acidic components, in
OF
, with a similar recovery compared with plasma. Therefore, drug adherence testing in
OF
should be further explored as a noninvasive approach, which can easily be performed in an “out‐of‐office” setting.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
8 articles.
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