MSACL 2019 EU Abstract

Developing an LC-MS/MS Method for 29 Antihypertensive Drugs in Urine

Melissa McNaughton (1,2), Paul Cawood (2)
(1) University of Manchester, (2) NHS Lothian

Warning: Undefined variable $headshot in /var/www/html/view_abstract/view_abstract_in_program.php on line 704

Melissa McNaughton (Presenter) NHS >> POSTER (PDF)

Presenter Bio: I completed a degree and a PhD in biochemistry at the University of Strathclyde in Glasgow. Currently, I am a trainee clinical biochemist working for the NHS in Edinburgh in Scotland where LC-MS/MS method development is part of my role. I recently developed a method for measuring antihypertensive drugs in patient urine for compliance testing which we are in the process of developing into a routine service in NHS Lothian.

Relevant Financial Disclosures (within past 24 months) No relevant financial relationship(s) to disclose. Conflict mitigation NOT REQUIRED.

Introduction: Hypertension is a major preventable cause of morbidity and mortality which affects one in four adults. Despite this, high rates of non-adherence to antihypertensive medications have been reported both in the U.K. and worldwide. Poor adherence to medications results in wasted resources, sub optimal treatment and worse health outcomes for patients. Objective measurements of adherence to treatment for hypertension such as LC-MS/MS measurement of drugs in urine have been proven to help identify these patients and allow therapy to be adapted. This has in turn improved patient outcomes. In NHS Lothian in Edinburgh, an initial pilot audit revealed that only 64% of patients with resistant hypertension adhered to their treatment regimen. This prompted the development of a local LC-MS/MS method to measure antihypertensive drugs in urine.
Aims:
1. To develop a qualitative LC-MS/MS method in NHS Lothian to test patient urine for 29 currently prescribed antihypertensive medications.
2. To validate the method for clinical application.
3. To use the method to estimate rates of non-adherence to antihypertensive therapy in NHS Lothian patients.
Results:
1. 22 of 29 antihypertensive medications chosen were able to be measured in patient urine.
2. 94% of patients with hypertension in NHS Lothian were fully adherent to medication (n=89 patient urines).
3. Of the patients with resistant hypertension (non-responders to treatment), 69% were adherent to medication. Three of these patients were partially adherent and one was completely non-adherent to therapy (total n=13).
Conclusions: An LC-MS/MS method has been developed which allows the identification of 22 of 29 antihypertensive drugs in patient urine. Validation work to include the remaining drugs and develop a routine service is ongoing.