Manchester researchers lead the way in large-scale medication adherence screening

The urine test, developed by researchers from Manchester University NHS Foundation Trust (MFT) and The University of Manchester (UoM), can detect 64 drugs prescribed in diabetes, cardiology, nephrology (kidney), rheumatology and lipid clinics.

The Manchester team first developed a test in 2018 to screen for non-adherence to blood pressure-lowering medications. They were the first in the North West of England to offer this test to patients and clinicians.

The highly sensitive and specific test detected the presence of almost all commonly prescribed medications for high blood pressure in a single spot-urine sample and has been instrumental in revealing alarmingly high rates of non-adherence in the North West.

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.

This follows a consultation with MFT medical consultants, which was led by Professor Maciej Tomaszewski, Honorary Consultant Physician at MFT and Co-Theme Lead for the Integrative Cardiovascular Medicine Theme at the NIHR BRC: Manchester.

The research team then shortlisted many medications other than those that lower blood pressure and further developed the test. The latest version of it can now detect 64 medications including those for diabetes and kidney disease, making MFT’s lab one of only two in the country to carry out this scale of testing.

Professor Maciej Tomaszewski, who is also, Professor of Cardiovascular Medicine at UoM, and Deputy Director of British Heart Foundation Manchester Centre of Research Excellence, 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 Biomedical Research Centre: Manchester 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 per cent of patients. This is largely caused by high numbers of patients not taking their medications correctly or at all.

Ensuring patients with diabetes take their medication correctly is key for maintaining target blood sugar levels, preventing long-term complications with blood vessels which can cause damage to the eyes, kidneys and nerves, and reducing mortality. By not taking medication as prescribed patients risk their condition worsening.

Dr Ed Hinchliffe, Consultant Clinical Scientist at MFT, 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 specialists can support and tailor care for their patients who do not take their medication as prescribed. This work can now benefit even more of our patients, doctors and the healthcare system.”

The test was developed by researchers from MFT’s Clinical Biochemistry Department, in collaboration with UoM’s Division of Cardiovascular Sciences and Manchester Molecular Pathology Innovation Centre (MMPathIC).

The Clinical Biochemistry Department at MFT remains the only NHS laboratory in the North West region of England to offer this test and it is now being utilised across a range of medical specialities who prescribe disease-modifying medications.

Professor Jacky Smith, Honorary Consultant at Wythenshawe Hospital and Inflammation Cluster Lead at the NIHR BRC: Manchester, of which the Integrative Cardiovascular Medicine Theme is a part of, said: “We are delighted that the Inflammation Cluster could support this innovative work which will be of wide-ranging benefit for patients in Manchester across several different conditions.”