Screening for non-adherence to antihypertensive treatment as a part of the diagnostic pathway to renal denervation

Renal denervation is a potential therapeutic option for resistant hypertension. a thorough clinical assessment to exclude reversible/spurious causes of resistance to antihypertensive therapy is required prior to this procedure. the extent to which non-adherence to antihypertensive treatment contributes to apparent resistance to antihypertensive therapy in patients considered for renal denervation is not known. patients (n=34) referred for renal denervation entered the evaluation pathway that included screening for adherence to antihypertensive treatment by high-performance liquid chromatography-tandem mass spectrometry-based urine analysis. biochemical non-adherence to antihypertensive treatment was the most common cause of non-eligibility for renal denervation—23.5% of patients were either partially or completely non-adherent to prescribed antihypertensive treatment. about 5.9% of those referred for renal denervation had admitted non-adherence prior to performing the screening test. suboptimal pharmacological treatment of hypertension and ‘white-coat effect’ accounted for apparently resistant hypertension in a further 17.7 and 5.9% of patients, respectively. taken together, these three causes of pseudo-resistant hypertension accounted for 52.9% of patients referred for renal denervation. only 14.7% of referred patients were ultimately deemed eligible for renal denervation. without biochemical screening for therapeutic non-adherence, the eligibility rate for renal denervation would have been 38.2%. non-adherence to antihypertensive treatment and other forms of therapeutic pseudo-resistance are by far the most common reason of ‘resistant hypertension’ in patients referred for renal denervation. we suggest that inclusion of biochemical screening for non-adherence to antihypertensive treatment may be helpful in evaluation of patients with ‘resistant hypertension’ prior to consideration of renal denervation.