Comparison of Morisky Medication Adherence Scale with therapeutic drug monitoring in apparent treatment-resistant hypertension

Ambarish Pandey, Fayez Raza, Alejandro Velasco, Stephanie Brinker, Colby Ayers, Sandeep R. Das, Donald E. Morisky, Ethan A. Halm, Wanpen Vongpatanasin

Research output: Contribution to journalArticlepeer-review

69 Scopus citations


The Morisky Medication Adherence Scale (MMAS-8) is a questionnaire developed for screening of non-adherence in patients with several chronic conditions, including uncomplicated hypertension. However, its accuracy in predicting non-adherence in patients with apparent treatment-resistant hypertension (a-TRH) is not known. Accordingly, we performed a retrospective study in 47 patients with a-TRH who had completed the eight-item MMAS during the initial clinic visit. Non-adherence was defined as presence of undetected serum levels of at least one prescribed antihypertensive drug by therapeutic drug monitoring. We found that 26% of patients were considered to have low adherence score (<6), while the actual prevalence of non-adherence was 51% by therapeutic drug monitoring. Sensitivity of the MMAS-8 was 26% (95% confidence interval, 10.3%-48.4%) with specificity of 75% (95% confidence interval, 53.3%-90.2%). By multivariate analysis, the MMAS-8 score was not an independent predictor of non-adherence, while certain clinical parameters such as heart rate were found to be independent predictors of non-adherence. Our study suggested limited accuracy of the MMAS-8 in detecting medication non-adherence in a-TRH. J Am Soc Hypertens 2015;9(6):420-426.

Original languageEnglish (US)
Pages (from-to)420-426.e2
JournalJournal of the American Society of Hypertension
Issue number6
StatePublished - 2015
Externally publishedYes


  • Blood pressure control
  • Self reported adherence
  • Serum drug levels

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine


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