Cost‐Effectiveness of Therapeutic Drug Monitoring in Diagnosing Primary Aldosteronism in Patients With Resistant Hypertension
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- Alejandro Velasco
- Hypertension Section University of Texas Southwestern Medical Center Dallas TX
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- Oliver Chung
- Department of Cardiology Charité – Universitätsmedizin Berlin Berlin Germany
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- Fayez Raza
- Internal Medicine Department University of Texas Southwestern Medical Center Dallas TX
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- Ambarish Pandey
- Internal Medicine Department University of Texas Southwestern Medical Center Dallas TX
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- Stephanie Brinker
- Internal Medicine Department University of Texas Southwestern Medical Center Dallas TX
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- Debbie Arbique
- Hypertension Section University of Texas Southwestern Medical Center Dallas TX
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- Angela Price
- Hypertension Section University of Texas Southwestern Medical Center Dallas TX
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- Yair Lotan
- Urology Department University of Texas Southwestern Medical Center Dallas TX
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- Sandeep R. Das
- Cardiology Division University of Texas Southwestern Medical Center Dallas TX
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- Wanpen Vongpatanasin
- Hypertension Section University of Texas Southwestern Medical Center Dallas TX
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説明
<jats:p>Primary aldosteronism (<jats:styled-content style="fixed-case">PA</jats:styled-content>) is present in up to 20% of patients with treatment‐resistant hypertension (<jats:styled-content style="fixed-case">TRH</jats:styled-content>). Investigation for <jats:styled-content style="fixed-case">PA</jats:styled-content> in patients with <jats:styled-content style="fixed-case">TRH</jats:styled-content> is recommended by current guidelines after medication nonadherence is excluded. Studies using therapeutic drug monitoring (<jats:styled-content style="fixed-case">TDM</jats:styled-content>) have shown that >50% of patients with <jats:styled-content style="fixed-case">TRH</jats:styled-content> are nonadherent to their prescribed antihypertensive medications. However, the relationship between the prevalence of <jats:styled-content style="fixed-case">PA</jats:styled-content> and medication adherence as confirmed by <jats:styled-content style="fixed-case">TDM</jats:styled-content> has not been previously assessed. A retrospective analysis from a hypertension referral clinic showed that prevalence of <jats:styled-content style="fixed-case">PA</jats:styled-content> in adherent patients with <jats:styled-content style="fixed-case">TRH</jats:styled-content> by <jats:styled-content style="fixed-case">TDM</jats:styled-content> was significantly higher than in nonadherent patients (28% vs 8%, <jats:italic>P</jats:italic><.05). Furthermore, cost analysis showed that <jats:styled-content style="fixed-case">TDM</jats:styled-content>‐guided <jats:styled-content style="fixed-case">PA</jats:styled-content> screening was $590.69 less expensive per patient, with minimal impact on the diagnostic accuracy. These data support a <jats:styled-content style="fixed-case">TDM</jats:styled-content>‐guided <jats:styled-content style="fixed-case">PA</jats:styled-content> screening approach as a cost‐saving strategy compared with routine <jats:styled-content style="fixed-case">PA</jats:styled-content> screening for <jats:styled-content style="fixed-case">TRH</jats:styled-content>.</jats:p>
収録刊行物
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- The Journal of Clinical Hypertension
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The Journal of Clinical Hypertension 17 (9), 713-719, 2015-04-27
Wiley