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Innovative screening method for non-adherence to antihypertensive medications

15 May 2019

New in-house urine test will identify patients who fail to take their blood pressure lowering medications


Researchers in the Division of Cardiovascular Sciences have collaborated with Manchester Molecular Pathology Innovation Centre (MMPathIC) and Manchester University NHS Foundation Trust (MFT) Clinical Biochemistry Department to develop an in-house urine test to screen for non-adherence to antihypertensive medications.

High blood pressure (hypertension) is the UK’s third biggest risk factor for all disease, costing the NHS more than £2.1 billion every year.  Although treatment for hypertension is proven to be effective, target blood pressures are only achieved in 40-50% of patients – largely due to many not taking their medication correctly or not at all (non-adherence). It is thought that non-adherence is influenced by the fact that patients with hypertension rarely have noticeable symptoms, however the associated health risks for patients with hypertension remain high.

Previously routine clinical laboratory services for urine antihypertensive screening was limited to two centres outside the North West. To address this, Professor of Cardiovascular Medicine, Maciej Tomaszewski and Ed Hinchliffe, Principal Clinical Biochemist at Manchester University NHS Foundation Trust, (MFT) developed the in-house urine test screening and the Clinical Biochemistry Department is the first to offer the test to patients and clinicians in the North West.

The University’s Manchester Molecular Pathology Innovation Centre (MMPathIC) supported the project, providing funding to enable the test’s development and validation.

The test utilises High Performance Liquid Chromatography, coupled with High Resolution Accurate Mass Mass-Spectrometry (HRAM-MS) and represents the first detailed application of urine antihypertensive screening utilising this analytical platform. The highly sensitive and specific test detects the presence of all commonly prescribed antihypertensives in a single spot-urine sample and has been instrumental in revealing alarmingly high rates of non-adherence in the region.

This type of screening can assist doctors in identifying patients with uncontrolled hypertension who fail to take their prescribed medication and help them target the main reason for this non-adherence. This is a major step forward in improving the long-term clinical outcomes for these patients and will lead to an improvement in blood pressure control, adherence, and a reduction in healthcare costs. 

This method for antihypertensive screening in urine is now embedded into routine clinical service at MFT placing the Clinical Biochemistry Department in an important position to provide referral services for other UK clinical laboratories and offer the test to hospitals and practices across the North-West.

Professor Tomaszewski said: “The access to the new diagnostic test will transform the way we manage hypertension and resistant hypertension locally at MFT and beyond – in Greater Manchester. The test offers a more stratified approach to both diagnosis and therapy of high blood pressure and will benefit patients, doctors and the healthcare system”.

Professor Tomaszewski’s team was awarded £754K from the British Heart Foundation to carry out a three year clinical study, utilising the results of the urine test, to assess whether a simple five step intervention can encourage people to take their blood pressure medication properly and lead to an improvement in blood pressure.  MMPathIC are leading the health economic analysis for the project to establish if the intervention can save money for the NHS.