부산대학교 도서관

OBJECTIVE:: In the European Peregrine post-market (PM) study, alcohol-mediated renal denervation (AMRDN) using the Peregrine Catheter was followed by a significant office (18/10 ± 21/11 mmHg) and 24-hour ambulatory (11/7 ± 14/9 mmHg) BP reduction at 6 months in patients remaining uncontrolled despite prescription of >/= 3 antihypertensive drugs. In the current analysis, we report the level and changes in drug adherence in patients included in the study, and look for the influence of drug adherence on ambulatory BP changes after AMRDN. DESIGN AND METHOD:: Detection of antihypertensive drugs was performed in the urine using high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS), both at baseline, and during follow-up (1, 3 and 6 months after AMRDN). Full adherence, partial adherence and non-adherence to drug treatment were defined as all analyzable drugs detected, 1 analyzable drug not detected and >/= 2 analyzable drugs not detected, respectively. RESULTS:: AMDR was successfully performed in 45 patients (62% males, mean age 55 ± 10 y, BMI 31 ± 6 kg/m2, mean eGFR 83 ± 17 ml/min/1,73m2). At baseline, the proportion of fully adherent, partially adherent and non-adherent patients was 60% (n = 27), 18% (n = 8) and 22% (n = 10), respectively. At 6 months, 28% of patients (n = 12) improved adherence, 44% (n = 19) had no change in drug adherence and 28% (n = 12) had worse adherence compared to baseline. Mean 24-hour ambulatory systolic BP decreased by 10 ± 13, 10 ± 4 and 14 ± 19 mmHg in fully adherent, partially adherent, and non-adherent patients (p = 0.92), by 15 ± 13, 8 ± 12 and 14 ± 18 mmHg in patients who improved, maintained or decreased adherence (p = 0.33) and by 9.1 ± 11 and 13 ± 15 mmHg in patients who remained adherent throughout the whole study vs. patients whose adherence was <80% on at least one follow-up visit (p = 0.51), respectively. CONCLUSIONS:: In agreement with previous reports, 40% of patients included in the Peregrine PM study were not fully adherent to drug treatment, and adherence decreased further over time in 28% of patients. Nevertheless, there was no signal suggesting that BP response to AMRDN may depend on drug adherence. The true impact of adherence level on BP response to AMRDN will need confirmation in ongoing sham-controlled randomized trials.