Resistant hypertension is defined as blood pressure remaining above goal despite treatment with three or more antihypertensive medications. However, resistance is often caused by prescription noncompliance rather than true treatment resistance.
Mayo Clinic Laboratories has developed an antihypertensive panel that can determine if a patient has taken their prescribed medications within the past 24 hours. Evidence of noncompliance assists physicians in counseling patients and avoiding overprescription of additional medications.
The drugs included in the panel along with their reference ranges are listed below:
- Amlodipine: 400 ng/mL
- Atenolol: 800 ng/mL
- Bumetanide: 40 ng/mL
- Carvedilol: 40 ng/mL
- Chlorthalidone: 4 ng/mL
- Clonidine: 40 ng/mL
- Furosemide: 4 ng/mL
- Hydralazine: 400 ng/mL
- Hydrochlorothiazide: 10 ng/mL
- Labetalol: 40 ng/mL
- Lisinopril: 1,000 ng/mL
- Losartan: 4 ng/mL
- Metoprolol: 40 ng/mL
- 7-alpha-Thiomethylspironolactone: 10 ng/mL
- Terazosin: 4 ng/mL
- Torsemide: 40 ng/mL
Drugs are detected by liquid chromatography tandem mass spectrometry (LC/MS/MS). Medications are reported as either detected or not detected. Specific concentrations are not given.
Specimen requirement is 4 mL of urine collected in a tube without preservative.
References
Gupta P, Patel P, et al. Biochemical screening for nonadherence is associated with blood pressure reduction and improvement in adherence. Hypertension. 2017;70(5):1042-1048.
Tomaszewski M, et al. High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) urine analysis. Heart. 2014;100(11):855-861.
Peeters LEJ, et al. The effect of combining therapeutic drug monitoring of antihypertensive drugs with personalised feedback on adherence and resistant hypertension: the (RHYME-RCT) trial protocol of a multi-centre randomised controlled trial. BMC Cardiovasc Disord. 2023;23(1):87.
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