Therapeutic drug monitoring of amlodipine and the Z-FHL/HHL ratio : Adherence tools in patients referred for apparent treatment-resistant hypertension

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dc.contributor.authorJones, E. S. W.en_ZA
dc.contributor.authorLesosky, M.en_ZA
dc.contributor.authorBlockman, M.en_ZA
dc.contributor.authorCastel, S.en_ZA
dc.contributor.authorDecloedt, E. H.en_ZA
dc.contributor.authorSchwager, S. L. U.en_ZA
dc.contributor.authorSturrock, E. D.en_ZA
dc.contributor.authorWiesner, L.en_ZA
dc.contributor.authorRayner, B. L.en_ZA
dc.date.accessioned2018-11-28T09:08:27Z
dc.date.available2018-11-28T09:08:27Z
dc.date.issued2017
dc.descriptionCITATION: Jones, E. S. W., et al. 2017. Therapeutic drug monitoring of amlodipine and the Z-FHL/HHL ratio : Adherence tools in patients referred for apparent treatment-resistant hypertension. South African Medical Journal, 107(10):887-891, doi:10.7196/SAMJ.2017.v107i10.12268.
dc.descriptionThe original publication is available at http://www.samj.org.za
dc.description.abstractBackground. Non-adherence to antihypertensives is a cause of ‘pseudo-treatment-resistant’ hypertension. Objective. To determine whether monitoring plasma amlodipine concentrations and inhibition of angiotensin-converting enzyme (ACE) can be adjunct adherence tools. Methods. Patients with hypertension who were prescribed enalapril and amlodipine were enrolled. Blood pressures (BPs) were monitored and an adherence questionnaire was completed. Steady-state amlodipine was assayed using liquid chromatography-mass spectrometry and degree of ACE inhibition using the Z-FHL/HHL (z-phenylalanine-histidine-leucine/hippuryl-histidine-leucine) ratio. Results. One hundred patients (mean (standard deviation) age 50.5 (12) years, 46% male) were enrolled. Based on plasma assays, 26/97 patients (26.8%) were unsuppressed by enalapril and 20/100 (20%) were sub-therapeutic for amlodipine. There were significant BP differences based on plasma levels of the medication: 21/20 mmHg lower in the group with suppressed ACE and 26/20 mmHg in the group with steady-state amlodipine concentrations. Conclusions. Monitoring antihypertensive adherence by assaying plasma medication concentrations is a feasible option for evaluating true v. pseudo-resistant hypertension.en_ZA
dc.description.urihttp://www.samj.org.za/index.php/samj/article/view/12074
dc.description.versionPublisher's version
dc.format.extent5 pages
dc.identifier.citationJones, E. S. W., et al. 2017. Therapeutic drug monitoring of amlodipine and the Z-FHL/HHL ratio : Adherence tools in patients referred for apparent treatment-resistant hypertension. South African Medical Journal, 107(10):887-891, doi:10.7196/SAMJ.2017.v107i10.12268
dc.identifier.issn2078-5135 (online)
dc.identifier.issn0256-9574 (print)
dc.identifier.otherdoi:10.7196/SAMJ.2017.v107i10.12268
dc.identifier.urihttp://hdl.handle.net/10019.1/104741
dc.language.isoen_ZAen_ZA
dc.publisherHealth & Medical Publishing Group
dc.rights.holderHealth & Medical Publishing Group
dc.subjectTherapeutic drug monitoringen_ZA
dc.subjectHypertension -- Treatmenten_ZA
dc.subjectDrug monitoringen_ZA
dc.subjectAmlodipineen_ZA
dc.subjectHypotensive agentsen_ZA
dc.subjectPlasma diagnosticsen_ZA
dc.titleTherapeutic drug monitoring of amlodipine and the Z-FHL/HHL ratio : Adherence tools in patients referred for apparent treatment-resistant hypertensionen_ZA
dc.typeArticleen_ZA
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