Adherence to Antihypertensive Drugs Assessed by Hyphenated High-Resolution Mass Spectrometry Analysis of Oral Fluids

Background It is currently unknown if antihypertensive drugs can be monitored in oral fluid (OF) using liquid chromatography coupled to high-resolution mass spectrometry. Methods and Results We assessed adherence using liquid chromatography coupled to high-resolution mass spectrometry inOF, plasma, and urine of 56 consecutive patients with hypertension referred to a tertiary hypertension unit. Of these patients, 59% were completely adherent (all drugs detectable in urine), whereas 29% and 13% were partially adherent (1 drug not detectable in urine) or nonadherent (>1 drug not detectable in urine), respectively. Adherent patients were on fewer antihypertensive drugs (P=0.001), had fewer daily drug doses (P=0.012), and had lower 24-hour ambulatory systolic (P=0.012) and diastolic (P=0.009) blood pressures than nonadherent or partially adherent patients. Most drugs were detected in urine compared with plasma andOF(181 versus 119 versus 88;P=0.001). Compared with urine and plasma, detection rates of angiotensin-converting enzyme inhibitors, angiotensinIIreceptor blockers, and diuretics were lower inOF. There was no difference in the frequency of detecting beta blockers (P=1.0) and calcium channel blockers (P=0.063) when comparingOFwith urine. There was no difference in the number of calcium channel blockers (P=0.727), beta blockers (P=1.000), thiazide diuretics (P=0.125), and alpha-2 agonists (P=0.125) identified betweenOFand plasma. Conclusions This study shows the feasibility of drug adherence testing for several antihypertensive drugs, especially those without acidic components, inOF, with a similar recovery compared with plasma. Therefore, drug adherence testing inOFshould be further explored as a noninvasive approach, which can easily be performed in an "out-of-office" setting.