P1.11: True Antihypertensive Efficacy of Sequential Nephron Blockade in Patients with Resistant Hypertension and Confirmed Medication Adherence

Objective We previously showed that sequential-nephron blockade (SNB) was more effective than combined renin angiotensin system blockade (RB) for controlling BP in patients with resistant hypertension (RH). We assessed medication adherence (MA) on the antihypertensive (AHT) response to SNB/ RB with a new combined scoring system. Design and method Pts with daytime ambulatory SBP/DBP (dASBP/dADBP)≥135 and/or 85 mmHg, despite 4 week with irbesartan (Irb)+HCTZ+amlodipine, were randomised to SNB (n=82) or RB (n=82) for 12 weeks. MA was scored as: (i) plasma Irb concentration; (ii) urinary AcSDKP/creatinine ratio (UR); (iii) last medication intake before visit (LMI); and (iv) pill counting (PC, %). 1 point of MA score was attributed to Irb >20ng/ml, UR >4nmol/mmol, LMI 80%. MA was defined as low (LMA, score ≤2), intermediate (IMA, score=3), and optimal (OMA, score=4). Results Among 164 pts: 82 had OMA (46 SNB/36 RB), 52 IMA (23 SNB/29 RB) and 30 LMA (13 SNB/17 RB) (NS). LMA pts were younger than SMA pts (50±11 vs. 56±10 yrs, p