An Observational Registry to Assess Urinary Albumin Evolution in Saudi Hypertensive Patients with the Current Treatment Local algorithm: Results of the RATIONAL Study.

INTRODUCTION: Hypertension causes microalbuminuria, which if left uncontrolled could progress to kidney damage. Antihypertensive treatment primarily aims at controlling blood pressure (BP), but is also shown to control urine albumin excretion. This renoprotective role of antihypertensive medications consists of halting or reverting albuminuria progression. PATIENTS AND METHODS: A national Kingdom of Saudi Arabia (KSA), multicenter, observational, longitudinal study (RATIONAL), evaluated the correlation between BP control and microalbuminuria evolution over 1 year. Adult hypertensive patients with kidney damage were enrolled, after giving written consent. RESULTS: Of 409 patients, 60% had uncontrolled BP at baseline, down to 34% at 12 months. Over 80% of patients were on mono or double antihypertensive therapy, and angiotensin-receptor blockers (ARB) topped the list of medication classes. Albumin-creatinine ratio (ACR) significantly decreased throughout the study, indicating that BP control is paramount to prevent target organ damage. BP change most strongly correlated with ACR change upon triple therapy (ARB + calcium channel blocker + ß-blocker). Importantly, 25% (at 6 months) and 38% (at 12 months) of patients reverted back to normoalbuminuria, mostly upon renin-angiotensin system blockers. Around 80% of study patients had also diabetes, a common condition in KSA, which significantly hindered achievement of normoalbuminuria at 12 months. CONCLUSION: A modest but solid correlation between BP control and ACR reduction was identified. Results underline proper BP management in KSA and success of antihypertensive treatment in reverting microalbuminuria or delaying its progress. The study duration might be insufficient to reflect conclusively the beneficial effect of longer-term BP control on microalbuminuria evolution.

Prescription-level factors associated with primary nonadherence to dermatologic medications.

PURPOSE: To analyze factors associated with primary nonadherence to dermatologic medications and study whether prescription-level factors are associated with primary nonadherence. MATERIALS AND METHODS: A retrospective review of medical records of new dermatology patients from January 2011 to December 2013 at a single urban safety-net hospital outpatient dermatology clinic with a closed pharmacy system. RESULTS: A total of 4307 prescriptions were written for 2490 patients. The overall primary nonadherence rate was 24.7%. The most prescribed medication classes in order of frequency were topical corticosteroids, topical antibiotics, topical retinoids, oral antibiotics, and topical antifungals. After multivariable adjustment for patient, provider, and prescription characteristics, when compared to topical corticosteroids, topical antibiotics, oral antifungals, and oral antivirals were less likely to be filled (RR 0.9 [95% CI, 0.84-0.95]), (RR 0.69 [95% CI, 0.59-0.81]), and (RR 0.65 [95% CI, 0.46-0.93]), respectively. Conversely, topical vitamin D analogs, oral immunomodulators, and oral retinoids were more likely to be filled (RR 1.15 [95% CI, 1.02-1.28]), (RR 1.11 [95% CI, 1.04-1.19]), and (RR 1.15 [95% CI, 1.04-1.27]), respectively. CONCLUSIONS: Medication class or administration route may be associated with increased risk of nonadherence, and identifying these factors is important in considering ways to reduce primary nonadherence rates in dermatology.