Clinicians in Manchester can now use an expanded urine screen capable of identifying 64 prescribed medicines, after a programme that began as a check for blood pressure drugs was developed into a broader diagnostic tool for multiple long-term conditions.
From hypertension testing to multi-specialty screening
The test, which uses a single spot urine sample, was first introduced in 2018 by teams at Manchester University NHS Foundation Trust's Clinical Biochemistry Department in collaboration with the University of Manchester's Division of Cardiovascular Sciences and the Manchester Molecular Pathology Innovation Centre (MMPathIC).
Originally designed to detect 37 commonly prescribed antihypertensive agents, the assay helped clinicians distinguish patients with genuinely resistant hypertension from those whose blood pressure remained high because they were not taking prescribed medicines. Its routine use across the North West highlighted the scale of non-adherence and prompted work to broaden the technology's application.
Wider clinical reach after consultation
Following a 2023 consultation led by Professor Maciej Tomaszewski of the NIHR Manchester Biomedical Research Centre and the British Heart Foundation Manchester Centre of Research Excellence, the diagnostic platform was expanded. The latest iteration can detect medicines used in:
- diabetes clinics
- cardiology services
- nephrology care
- rheumatology clinics
- lipid management
This broader spectrum means clinicians across several specialties can now objectively check whether prescribed medicines are present in patients' urine, rather than relying on patient report or indirect measures such as blood pressure or biochemical markers.
Practical and clinical consequences
By identifying whether a drug is present in the body, the test can prevent unnecessary escalation of treatment when the true issue is non-adherence. That has immediate implications for patient safety — avoiding additional or higher-dose medications — and for resource use within the NHS.
Within cardiovascular care the test has already been used to clarify cases of uncontrolled blood pressure. Expanding the panel enables teams managing long-term conditions such as diabetes, kidney disease and inflammatory disorders to make the same distinction, potentially improving outcomes and tailoring adherence support.
| Year | Number of medicines detectable |
|---|---|
| 2018 (launch) | 37 |
| Latest version | 64 |
The test is reported to have high sensitivity and specificity for routinely prescribed agents when applied to a spot urine sample, attributes that underpin its clinical usefulness.
Research and implementation partners
The programme represents collaborative work between NHS laboratory services and academic groups: Manchester University NHS Foundation Trust's Clinical Biochemistry Department, the University of Manchester's Division of Cardiovascular Sciences, and MMPathIC. Leadership and strategic direction included input from the NIHR Manchester Biomedical Research Centre and the British Heart Foundation Manchester Centre of Research Excellence.
Clinical teams in the North West were early adopters, and the expanded panel followed discussion among Manchester clinicians about how the test could help specialties beyond cardiovascular medicine. That consultation process shaped which additional medicines were prioritised for detection.
Wider adoption elsewhere in the NHS would depend on local laboratory capacity, commissioning decisions and the clinical pathways into which the test is integrated. But the development underlines a growing trend for diagnostics that directly inform prescribing decisions and help clinicians target adherence support to the patients who need it most.
As services consider implementing the expanded assay, the immediate promise is clear: a simple urine test that offers objective evidence about whether medicines are being taken, enabling clinicians to act on facts rather than assumptions.
