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Directly Observed Therapy in Hypertension (DOT-HTN)

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Book cover Drug Adherence in Hypertension and Cardiovascular Protection

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

Abstract

Directly observed therapy (DOT), or witnessed intake of hypertensive patients’ prescribed medication - hereafter called DOT-HTN, has been introduced in hypertension research and reported in the literature since 2011 with emphasis on treatment resistant hypertensive (TRH) patients. The aim of this review is to identify how the DOT-HTN procedure has been applied in ongoing and published research. Researchers from four nations were identified being engaged in research of DOT in hypertensive patients. Five ongoing trials of different methodologies were identified, of which three investigated the use of DOT-HTN. Ten published reports, hereof five studies, were identified, and ten key points of information, including level of care, were identifiable in eight of ten reports describing the DOT-HTN procedures. Three reports had rather similar procedures with observed full dose of morning medications and a maximum of 2 hours of post-DOT-HTN observation. Three reports had longer observation time, two of them with medication administration intervals, and blood pressure measurement intervals. Two were case reports, describing severe post-DOT-HTN adverse reactions, contributing with important safety information. All reports either described safety measures or discussed the safety of the procedure. In eight of ten publications, no characteristics of the patients undergoing the procedure were described. Thus, reports are scarce and describe different DOT-HTN procedures, as well as lack data on patient characteristics. It is important that future research characterizes the patients who are found to be non-adherent after directly observed therapy of antihypertensive medications. It is equally important that randomized controlled trials are conducted, to investigate whether the DOT-HTN procedure is safe, and has effect on blood pressure in uncontrolled or treatment resistant hypertensive patients. Ethical challenges regarding the use of DOT-HTN exist and must be debated.

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References

  1. Cardiovascular and Renal Research Group 2018 [16 Mar 2018]. http://www.med.uio.no/klinmed/english/research/groups/cardiovascular-andrenal/index.html.

  2. Fadl Elmula FE, Hoffmann P, Fossum E, Brekke M, Gjonnaess E, Hjornholm U, et al. Renal sympathetic denervation in patients with treatment-resistant hypertension after witnessed intake of medication before qualifying ambulatory blood pressure. Hypertension. 2013;62(3):526–32.

    Article  CAS  PubMed  Google Scholar 

  3. Fadl Elmula FE, Hoffmann P, Larstorp AC, Fossum E, Brekke M, Kjeldsen SE, et al. Adjusted drug treatment is superior to renal sympathetic denervation in patients with true treatment-resistant hypertension. Hypertension. 2014;63(5):991–9.

    Article  CAS  PubMed  Google Scholar 

  4. Bunker J, Callister W, Chang CL, Sever PS. How common is true resistant hypertension? J Hum Hypertens. 2011;25(2):137–40.

    Article  CAS  PubMed  Google Scholar 

  5. Hameed MA, Tebbit L, Jacques N, Thomas M, Dasgupta I. Non-adherence to antihypertensive medication is very common among resistant hypertensives: results of a directly observed therapy clinic. J Hum Hypertens. 2016;30(2):83–9.

    Article  CAS  PubMed  Google Scholar 

  6. Zannad F, Stough WG, Mahfoud F, Bakris GL, Kjeldsen SE, Kieval RS, et al. Design considerations for clinical trials of autonomic modulation therapies targeting hypertension and heart failure. Hypertension. 2015;65(1):5–15.

    Article  CAS  PubMed  Google Scholar 

  7. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.

    Article  PubMed  Google Scholar 

  8. Chung O, Vongpatanasin W, Bonaventura K, Lotan Y, Sohns C, Haverkamp W, et al. Potential cost-effectiveness of therapeutic drug monitoring in patients with resistant hypertension. J Hypertens. 2014;32(12):2411–21.

    Article  CAS  PubMed  Google Scholar 

  9. Ceral J, Habrdova V, Vorisek V, Bima M, Pelouch R, Solar M. Difficult-to-control arterial hypertension or uncooperative patients? The assessment of serum antihypertensive drug levels to differentiate non-responsiveness from non-adherence to recommended therapy. Hypertens Res. 2011;34(1):87–90.

    Article  CAS  PubMed  Google Scholar 

  10. Jung O, Gechter JL, Wunder C, Paulke A, Bartel C, Geiger H, et al. Resistant hypertension? Assessment of adherence by toxicological urine analysis. J Hypertens. 2013;31(4):766–74.

    Article  CAS  PubMed  Google Scholar 

  11. Strauch B, Petrak O, Zelinka T, Rosa J, Somloova Z, Indra T, et al. Precise assessment of noncompliance with the antihypertensive therapy in patients with resistant hypertension using toxicological serum analysis. J Hypertens. 2013;31(12):2455–61.

    Article  CAS  PubMed  Google Scholar 

  12. Tomaszewski M, White C, Patel P, Masca N, Damani R, Hepworth J, et al. High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis. Heart. 2014;100(11):855–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Fadl Elmula FE, Jin Y, Yang WY, Thijs L, Lu YC, Larstorp AC, et al. Meta-analysis of randomized controlled trials of renal denervation in treatment-resistant hypertension. Blood Press. 2015;24(5):263–74.

    Article  PubMed  Google Scholar 

  14. Linicus Y, Kindermann I, Helfer AG, Meyer MR, Maurer HH, Mahfoud F, et al. Witnessed drug intake before planned denervation—always harmless? Int J Cardiol. 2015;179:125–6.

    Article  PubMed  Google Scholar 

  15. Allain TJ, van Oosterhout JJ, Douglas GP, Joukes S, Gadabu OJ, Darts C, et al. Applying lessons learnt from the ‘DOTS’ Tuberculosis Model to monitoring and evaluating persons with diabetes mellitus in Blantyre, Malawi. Trop Med Int Health. 2011;16(9):1077–84.

    Article  PubMed  Google Scholar 

  16. World Health Organization. WHO Tuberculosis Programme; Framework for effective tuberculosis control 1994 [Search performed 02 May 2016]. http://apps.who.int/iris/handle/10665/58717. Accessed 16 Mar 2018.

  17. Pasipanodya JG, Gumbo T. A meta-analysis of self-administered versus directly observed therapy effect on microbiologic failure, relapse, and acquired drug resistance in tuberculosis patients. Clin Infect Dis. 2013;57(1):21–31. https://doi.org/10.1093/cid/cit167.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Lonnroth K, Castro KG, Chakaya JM, Chauhan LS, Floyd K, Glaziou P, et al. Tuberculosis control and elimination 2010–50: cure, care, and social development. Lancet. 2010;375(9728):1814–29.

    Article  PubMed  Google Scholar 

  19. Volmink J, Garner P. Directly observed therapy for treating tuberculosis http://onlinelibrary.wiley.com. Wiley; 2012. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003343.pub3/abstract.

  20. Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, et al. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev. 2014;(4):CD007768.

    Google Scholar 

  21. Folkehelseinstituttet. Direkte observert behandling (DOT) [Search performed 16 Mar 2018]. https://www.fhi.no/globalassets/dokumenterfiler/rapporter/folkehelserapporten-2014-pdf.pdf (pp. 80–83).

  22. Hart JE, Jeon CY, Ivers LC, Behforouz HL, Caldas A, Drobac PC, et al. Effect of directly observed therapy for highly active antiretroviral therapy on virologic, immunologic, and adherence outcomes: a meta-analysis and systematic review. J Acquir Immune Defic Syndr. 2010;54(2):167–79.

    PubMed  PubMed Central  Google Scholar 

  23. Persu A, Jin Y, Azizi M, Baelen M, Volz S, Elvan A, et al. Blood pressure changes after renal denervation at 10 European expert centers. J Hum Hypertens. 2014;28(3):150–6.

    Article  PubMed  Google Scholar 

  24. Burnier M, Wuerzner G, Struijker-Boudier H, Urquhart J. Measuring, analyzing, and managing drug adherence in resistant hypertension. Hypertension. 2013;62(2):218–25.

    Article  CAS  PubMed  Google Scholar 

  25. World Health Organization 2003. Adherence to long-term therapies: evidence for action [Search performed 02 May 2016]. http://www.who.int/chp/knowledge/publications/adherence_report/en/. Accessed 16 Mar 2018.

  26. Waeber B, Feihl F. Assessment of drug compliance in patients with high blood pressure resistant to antihypertensive therapy. EuroIntervention. 2013;9 Suppl R:R29–34.

    Article  PubMed  Google Scholar 

  27. Rosa J, Widimsky P, Tousek P, Petrak O, Curila K, Waldauf P, et al. Randomized comparison of renal denervation versus intensified pharmacotherapy including spironolactone in true-resistant hypertension: six-month results from the Prague-15 study. Hypertension. 2015;65(2):407–13.

    Article  CAS  PubMed  Google Scholar 

  28. Azizi M, Sapoval M, Gosse P, Monge M, Bobrie G, Delsart P, et al. Optimum and stepped care standardised antihypertensive treatment with or without renal denervation for resistant hypertension (DENERHTN): a multicentre, open-label, randomised controlled trial. Lancet. 2015;385(9981):1957–65.

    Article  PubMed  Google Scholar 

  29. Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Bohm M. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet. 2010;376(9756):1903–9.

    Article  PubMed  Google Scholar 

  30. Bhatt DL, Kandzari DE, O’Neill WW, D’Agostino R, Flack JM, Katzen BT, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014;370(15):1393–401.

    Article  CAS  PubMed  Google Scholar 

  31. Kario K, Ogawa H, Okumura K, Okura T, Saito S, Ueno T, et al. SYMPLICITY HTN-Japan—first randomized controlled trial of catheter-based renal denervation in Asian patients. Circ J. 2015;79(6):1222–9.

    Article  CAS  PubMed  Google Scholar 

  32. Desch S, Okon T, Heinemann D, Kulle K, Rohnert K, Sonnabend M, et al. Randomized sham-controlled trial of renal sympathetic denervation in mild resistant hypertension. Hypertension. 2015;65(6):1202–8.

    Article  CAS  PubMed  Google Scholar 

  33. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2009 [Search performed 25 Mar 2016]. http://prismastatement.org/. Accessed 16 Mar 2018.

  34. Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Infor Libr J. 2009;26(2):91–108.

    Article  Google Scholar 

  35. International Committee of Medical Journal Editors (ICMJE). http://www.icmje.org/recommendations/browse/publishing-andeditorial-issues/clinical-trial-registration.html. Accessed 16 Mar 2018.

  36. World Health Organization. International Clinical Trials Registry Platform (ICTRP). http://www.who.int/ictrp/network/primary/en/. Accessed 16 Mar 2018.

  37. US National Library of Medicine National Institutes of Health [Search performed 31 Mar 2016]. http://www.ncbi.nlm.nih.gov/pubmed. Accessed 16 Mar 2018.

  38. Ovid MEDLINE [Search performed 31 Mar 2016]. http://ovidsp.ovid.com/. Accessed 16 Mar 2018.

  39. The Cochrane Library [Search performed 31 Mar 2016]. http://www.cochranelibrary.com/. Accessed 16 Mar 2018.

  40. EMBASE [Search performed 31 Mar 2016]. https://www.elsevier.com/solutions/embase-biomedical-research. Accessed 16 Mar 2018.

  41. Clinical Trials Gov. [Search performed 4 Jan 2016]. https://clinicaltrials.gov/ct2/results?cond=%22Hypertension%22. Accessed 16 Mar 2018.

  42. International Standard Randomized Clinical Trial Number [Search performed 23 Mar 2016]. http://www.isrctn.com/search?q=. Accessed 16 Mar 2018.

  43. EU Clinical Trials Register [Search performed 31 Mar 2016]. https://www.clinicaltrialsregister.eu/ctr-search/search. Accessed 16 Mar 2018.

  44. German Clinical Trials Register [Search performed 23 Mar 2016]. https://www.drks.de/drks_web/setLocale_EN.do. Accessed 16 Mar 2018.

  45. Netherlands Trial Register [Search performed 23 Mar 2016]. http://www.trialregister.nl/trialreg/index.asp. Accessed 16 Mar 2018.

  46. Australian New Zealand Clinical Trials Regestry [Search performed 23 Mar 2016]. http://www.anzctr.org.au/TrialSearch.aspx. Accessed 16 Mar 2018.

  47. Brazilian Registry of Clinical Trials [Search performed 23 Mar 2016]. http://www.ensaiosclinicos.gov.br/. Accessed 16 Mar 2018.

  48. Chinese Clinical Trial Register (ChiCTR) [Search performed 23 Mar 2016]. http://www.chictr.org.cn/abouten.aspx. Accessed 16 Mar 2018.

  49. Clinical Research Information Service (CRIS)—Korea 2016 [Search performed 23 Mar 2016]. http://www.who.int/ictrp/network/cris2/en/index1.html. Accessed 16 Mar 2018.

  50. Clinical Trials Registry India (CTRI) [Search performed 23 Mar 2016]. http://ctri.nic.in/Clinicaltrials/login.php. Accessed 16 Mar 2018.

  51. The Pan African Clinical Trials Registry (PACTR) [Search performed 23 Mar 2016]. http://www.pactr.org/. Accessed 16 Mar 2018.

  52. Cuban Registry of Clinical Trials (RPCEC) [Search performed 23 Mar 2016]. http://registroclinico.sld.cu/en/home. Accessed 16 Mar 2018.

  53. Iranian Registry of Clinical Trials (IRCT) [Search performed 23 Mar 2016]. http://irct.ir/. Accessed 16 Mar 2018.

  54. Miroslawska A, Solbu M, Skjolsvik E, Toft I, Steigen TK. Renal sympathetic denervation: effect on ambulatory blood pressure and blood pressure variability in patients with treatment-resistant hypertension. The ReShape CV-risk study. J Hum Hypertens. 2016;30(3):153–7.

    Article  CAS  PubMed  Google Scholar 

  55. EU Clinical Trials Register EudraCT2005-001004-39 [Search performed 23 Mar 2016]. https://www.clinicaltrialsregister.eu/ctrsearch/trial/2005-001004-39/GB#A. Accessed 16 Mar 2018.

  56. EU Clinical Trials Register EudraCT2013-001227-40 [Search performed 23 Mar 2016]. https://www.clinicaltrialsregister.eu/ctrsearch/trial/2013-001227-40/NO#A. Accessed 16 Mar 2018.

  57. ISRCTN57475376 Diagnosing and treating severe hypertension [Search performed 23 Mar 2016]. http://www.isrctn.com/search?q=directly+observed+therapy&filters=condition%3Acir-culatory+system&searchType=advanced-search. Accessed 16 Mar 2018.

  58. ClinicalTrialGov NCT02362893 Treatment of hypertension: an interventional approach to improve blood pressure control (DRIVE) [Searched performed 23 Mar 2016]. https://clinicaltrials.gov/ct2/show/NCT02362893?term=nct02362893&rank=1. Accessed 16 Mar 2018.

  59. ClinicalTrialGov NCT02513524 Prevalence of resistant hypertension with DOT (DOT) [Search performed 23 Mar 2016]. https://clinicaltrials.gov/ct2/show/NCT02513524. Accessed 16 Mar 2018.

  60. Ruzicka M, Hiremath S. Can drugs work in patients who do not take them? The problem of non-adherence in resistant hypertension. Curr Hypertens Rep. 2015;17(9):579.

    Article  PubMed  Google Scholar 

  61. Eskas PA, Heimark S, Eek Mariampillai J, Larstorp AC, Fadl Elmula FE, Hoieggen A. Adherence to medication and drug monitoring in apparent treatment-resistant hypertension. Blood Press. 2016;25(4):199–205.

    Article  CAS  PubMed  Google Scholar 

  62. Ruzicka M, McCormick B, Leenen FH, Froeschl M, Hiremath S. Adherence to blood pressure-lowering drugs and resistant hypertension: should trial of direct observation therapy be part of preassessment for renal denervation? Can J Cardiol. 2013;29(12):1741.e1–3.

    Article  Google Scholar 

  63. Brown MJ. Resistant hypertension: resistance to treatment or resistance to taking treatment? Heart. 2014;100(11):821–2.

    Article  PubMed  Google Scholar 

  64. McCormack GR, Virk JS. Driving towards obesity: a systematized literature review on the association between motor vehicle travel time and distance and weight status in adults. Prev Med. 2014;66:49–55.

    Article  PubMed  Google Scholar 

  65. The Cochrane Collaboration [Search performed 10 May 2016]. http://www.cochrane.org/. Accessed 16 Mar 2018.

  66. The Campbell Collaboration [Search performed 10 May 2016]. http://www.campbellcollaboration.org/. Accessed 16 Mar 2018.

  67. Godlee F. The Cochrane Collaboration. BMJ. 1994;309(6960):969–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Griffin BR, Schinstock CA. Thinking beyond new clinical guidelines: update in hypertension. Mayo Clin Proc. 2015;90(2):273–9.

    Article  PubMed  Google Scholar 

  69. Altman DG. Practical statistics for medical research. London: Chapman and Hall; 1991. XII, 611 s. : ill. p.

    Google Scholar 

  70. Ghofrani H, Weaver FA, Nadim MK. Resistant hypertension: medical management and alternative therapies. Cardiol Clin. 2015;33(1):75–87.

    Article  PubMed  Google Scholar 

  71. Lemstra M, Alsabbagh MW. Proportion and risk indicators of nonadherence to antihypertensive therapy: a meta-analysis. Patient Prefer Adherence. 2014;8:211–8.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Matthes J, Albus C. Improving adherence with medication: a selective literature review based on the example of hypertension treatment. Deutsch Arztebl Int. 2014;111(4):41–7.

    Google Scholar 

  73. Marshall IJ, Wolfe CDA, McKevitt C. Lay perspectives on hypertension and drug adherence: systematic review of qualitative research. BMJ. 2012;345:e3953.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Chen SL, Lee WL, Liang T, Liao IC. Factors associated with gender differences in medication adherence: a longitudinal study. J Adv Nurs. 2014;70(9):2031–40.

    Article  PubMed  Google Scholar 

  75. Gwadry-Sridhar FH, Manias E, Lal L, Salas M, Hughes DA, Ratzki-Leewing A, et al. Impact of interventions on medication adherence and blood pressure control in patients with essential hypertension: a systematic review by the ISPOR medication adherence and persistence special interest group. Value Health. 2013;16(5):863–71.

    Article  PubMed  Google Scholar 

  76. Rosenbaum L. Beyond belief—how people feel about taking medications for heart disease. N Engl J Med. 2015;372(2):183–7.

    Article  CAS  PubMed  Google Scholar 

  77. Zheng S, Nath V, Coyne DW. ACE inhibitor-based, directly observed therapy for hypertension in hemodialysis patients. Am J Nephrol. 2007;27(5):522–9.

    Article  CAS  PubMed  Google Scholar 

  78. Kalra S, Gupta Y. DOT (directly observed therapy) in diabetes: current thought, future reality. Aust J Rural Health. 2014;22(4):206.

    Article  PubMed  Google Scholar 

  79. Cioe PA, Stein MD, Promrat K, Friedmann PD. A comparison of modified directly observed therapy to standard care for chronic hepatitis C. J Community Health. 2013;38(4):679–84.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Deen R. Use of direct observed therapy to confirm compliance in a warfarin clinic. J Patient Saf. 2011;7(4):232–3.

    Article  PubMed  Google Scholar 

  81. Zimmerman N. Telemonitoring of medication adherence in patients with major mental illness: watching the patient as well as the pills. Stud Health Technol Inform. 2012;182:189–96.

    PubMed  Google Scholar 

  82. Heimark S, Eskas PA, Mariampillai JE, Larstorp AC, Hoieggen A, Fadl Elmula FE. Tertiary work-up of apparent treatment-resistant hypertension. Blood Press. 2016;25(5):312–8.

    Article  PubMed  Google Scholar 

  83. Persu A, Jin Y, Baelen M, Vink E, Verloop WL, Schmidt B, et al. Eligibility for renal denervation: experience at 11 European expert centers. Hypertension. 2014;63(6):1319–25.

    Article  CAS  PubMed  Google Scholar 

  84. Mariampillai JE, Eskås PA, Heimark S, Larstorp ACK, Fadl Elmula FEM, Høieggen A, Nortvedt P. Apparent treatment-resistant hypertension—patient.physician relationship and ethical issues. Blood Press. 2017;26:133–8.

    Article  PubMed  Google Scholar 

  85. McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67(3):267–77.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Kvale S, Brinkmann S, Anderssen TM, Jf R. Det kvalitative forskningsintervju. Oslo: Gyldendal akademisk; 2009. 344 s.: ill. p.

    Google Scholar 

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Authors and Affiliations

  1. Section of Cardiovascular and Renal Research, Oslo University Hospital, Ullevaal, Oslo, Norway

    Ulla Hjørnholm, Anne Cecilie Larstorp, Fadl Elmula M. Fadl Elmula, Aud Høieggen & Sverre E. Kjeldsen

  2. University of Oslo Library, University of Oslo, Oslo, Norway

    Mikaela Aamodt

  3. Department of Medical Biochemistry, Oslo University Hospital, Ullevaal, Oslo, Norway

    Anne Cecilie Larstorp

  4. Department of Acute Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway

    Fadl Elmula M. Fadl Elmula

  5. Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway

    Fadl Elmula M. Fadl Elmula & Sverre E. Kjeldsen

  6. Department of Nephrology, Oslo University Hospital, Ullevaal, Oslo, Norway

    Aud Høieggen

  7. Institute for Clinical Medicine, University of Oslo, Oslo, Norway

    Aud Høieggen & Sverre E. Kjeldsen

  8. Institute of Health and Society, University of Oslo, Oslo, Norway

    Marit Helen Andersen

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  1. Service of Nephrology and Hypertension, CHUV, University of Lausanne, Lausanne, Vaud, Switzerland

    Michel Burnier

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Hjørnholm, U. et al. (2018). Directly Observed Therapy in Hypertension (DOT-HTN). In: Burnier, M. (eds) Drug Adherence in Hypertension and Cardiovascular Protection. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-319-76593-8_6

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