The innovative NHS test developed in Manchester helps detect patients not taking their prescribed medications, which can often lead to further health problems.
In 2018 researchers in Manchester University NHS Foundation Trust (MFT) Clinical Biochemistry Department, in collaboration with The University of Manchester Division of Cardiovascular Sciences and Manchester Molecular Pathology Innovation Centre (MMPathIC), developed an in-house urine test to screen for non-adherence to blood pressure-lowering medications. They were the first to offer this test to patients and clinicians in the Northwest region of England, covering 37 medications.
The highly sensitive and specific test detected the presence of almost all commonly prescribed anti-hypertensives in a single spot-urine sample and has been instrumental in revealing alarmingly high rates of non-adherence in the region.
The introduction of the test to clinical practice at MFT has proven invaluable in identifying patients whose uncontrolled hypertension results from not taking their medications as prescribed rather than resistance to treatment.
In 2023, Professor Maciej Tomaszewski, Co-lead for the Integrated Cardiovascular Medicine Theme within the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre (BRC) and Deputy Director of the British Heart Foundation Manchester Centre of Research Excellence, conducted a consultation with MFT medical consultants to determine how to expand the testing in medical services and specialties other than hypertension.
This led the team to short-list many medications other than those that lower blood pressure and further develop the test. The latest version of the test can now detect 64 medications, including drugs prescribed in diabetes, cardiology, nephrology, rheumatology and lipid clinics, making MFT’s lab one of only two in the country to carry out this scale of testing.
Professor Maciej Tomaszewski, Professor of Cardiovascular Medicine at The University of Manchester and Honorary Consultant Physician at Manchester University NHS Foundation Trust, who led the expansion, said: “Seeing this test expanded into other medical specialties, and fully integrated into our routine diagnostic pipelines, is a fantastic moment for us. It is exciting to be working on innovations that are helping in better management of chronic health conditions. I am immensely grateful to NIHR Manchester BRC for funding this development.”
In the UK, high blood pressure (hypertension) is the third biggest risk factor for all disease (after smoking and poor diet) and costs the NHS over £2.1 billion every year. Although treatment for hypertension is proven to be effective, target blood pressures are only achieved in 40-50% of patients. This is, to a large extent, caused by high numbers of patients not taking their medications correctly, if at all, which is known as non-adherence.
Ensuring that diabetic patients take their medications is also key for maintaining target blood sugar levels, preventing long-term micro- and macrovascular complications, and reducing mortality. By not taking medication as prescribed patients risk exacerbating their condition further.
Dr Ed Hinchliffe, Consultant Clinical Scientist at Manchester University NHS Foundation Trust, who led the team’s work, said: “We are really proud to have further developed this test to help more specialists across a range of specialties. This will really help in how consultants can support and tailor care for their patients who fail to take their medication as prescribed. This work can now benefit even more of our patients, doctors and the healthcare system.”
The Clinical Biochemistry Department at MFT remains the only NHS laboratory in the North West region of England to offer this test and is now being utilised across a range of medical specialities who prescribe disease modifying medications.