Antihypertensive Group Research Articles

COMPARATIVE PHARMACOEPIDEMIOLOGICAL ASSESSMENT OF ANTIHYPERTENSIVE DRUGS PRESCRIPTION IN OUTPATIENT PRACTICE IN KURSK AND CHISINAU

Aim. To study the structure of medical prescriptions of antihypertensive agents for patients with arterial hypertension (HT) in the outpatient practice of Kursk (Russia) and Chisinau (Republic of Moldova).Material and methods. The questioning of doctors of medical organizations in Kursk and Chisinau was carried out as a one-stage descriptive study from October 2015 to February 2016. The questionnaires included questions on the pharmacoepidemiological aspects of prescribing antihypertensive drugs. Total number of respondents was 218, of them – 106 (26 cardiologists and 80 therapists) in Kursk and 112 (28 cardiologists and 84 therapists) in Chisinau.Results. In the real practice for HT treatment doctors in Kursk used more often beta-adrenoblockers (BAB), somewhat less often – angiotensinconverting enzyme (ACE) inhibitors, then diuretics. The shares of calcium channels blockers (CCB) and angiotensin II receptors blockers (ARB) were small – 8.8 and 5.2%, respectively. In Chisinau doctors gave preference to ACE inhibitors, then diuretics and BAB. Frequency of CCB prescriptions was almost identical to that of ARA – 13.7 and 13.6%, respectively. The additional antihypertensives, including central action drugs and alpha-adrenoblockers, were used rarely in both Chisinau and Kursk (1.3 and 1.6%, respectively). Doctors of Chisinau, when carrying out combined pharmacotherapy, gave priority to free combinations of antihypertensive drugs (64.4%), fixed combinations were used in 26.7% of cases. In Kursk, the ratio of these specified tactics of combined therapy was 53.5 and 34.1%, respectively. Among the pharmaceutical companies whose medicines were preferred by doctors in Kursk and in Chisinau, the leading positions were taken by KRKA (38.0 and 25.4%, respectively), Gideon Richter (13.5 and 28.7%, respectively) and Berlin-Chemie (26.7 and 15.6%, respectively).Conclusion. ACE inhibitors, diuretics, BAB were priority classes in the prescribing antihypertensive drugs according to survey of doctors in Kursk and Chisinau. In the conditions of the existing pharmaceutical market of Chisinau doctors used ARB and CCB more often than doctors from Kursk. The main share of doctor’s prescriptions in Kursk and Chisinau, considered both for group of antihypertensive drugs, and for certain representatives of each group of drugs, corresponds to the current recommendations on the pharmacotherapy of patients with HT.

Imidazoline receptors agonists: possible mechanisms of endothelioprotection

Imidazoline receptor agonists are one of the groups of contemporary antihypertensive drugs with the pleiotropic cardiovascular effects. In this review, the historical, physiological, pathophysiological aspects concerning imidazoline receptor agonists and possible mechanisms for their participation in endothelioprotection were considered. Illuminated the molecular biology of each subtype of imidazoline receptors and their significance in the pharmacological correction of cardiovascular disease.
 IR type 1 are localized in the brain nucleus, carrying out the descending tonic control of sympathetic activation, as well as in the endothelial cells of the vessels and kidneys. Their activation leads to a decrease in blood pressure, slowing the remodeling of the vascular wall and increasing sodium nares. IR type 2 is expressed predominantly in the adrenal gland, fat and muscle tissues. The physiological effects of their stimulation are associated with an increase in glucose utilization by peripheral tissues. IR type 3 are mainly present in pancreatic cells and are associated with the regulation of insulin secretion. Their stimulation leads to an increase in insulin liberation. Thus, IR agonists are able to improve endothelial function through various mechanisms, including blood pressure reduction, improvement in metabolic profile, and direct positive effects on the vascular wall.
 Current information on the pharmacological effects of this group compounds allows us to conclude that they are a promising group for correcting endothelial dysfunction and complications associated with it.

USE OF TRIPLE FIXED-DOSE ANTIHYPERTENSIVE DRUG COMBINATIONS IN RESISTANT HYPERTENSION – AMBULATORY BLOOD PRESSURE MONITORING RESULTS

Objective: To check the efficacy of triple fixed-dose antihypertensive drug combination as continuation of separate drug regime during the follow-up at repeated ambulatory blood pressure monitoring (ABPM) in out-patient clinic. Design and method: Triple fixed dose antihypertensive combination of perindopril, amlodipine and indapamide in four different dosage combinations is now available for 4 years. During years 2015 to 2017 we analysed 23 patients with resistant hypertension (16 men, 7 women) who had repeated ABPM procedures with time gap from 3 to 24 months, replacing separate drugs. Results: Patients’ age was 60 ± 11 years (37–79 years). During 1st ABPM average antihypertensive drug use was 3.3 ± 1.4 drugs (1–7 drug groups) with 61% of patients already taking the 3 studied drug groups separately (ACE inhibitor, diuretic and calcium channel blocker), or in double fixed combinations. 26% of patients were taking additional antihypertensive drug groups (e.g. beta blockers, alpha blockers, centrally acting drugs, spironolactone). During 2nd ABPM triple fixed-dose perindopril /indapamide/amlodipine was prescribed (10/2.5/10 mg in 78%, 10/2.5/5 mg in a single patient – 4% and 5/1.25/5 mg in 18% of patients). Drug usage was intensified to 4.2 ± 1.3 antihypertensive drugs (3–7 drugs). Additional drug groups were prescribed in 22% of patients (beta blockers in 2, alpha blocker in 3 patients) and in 2 patients drug regimen could be simplified with discontinued drug groups (beta blocker and alpha blocker). Average blood pressure during ABPM lowered from 151/84 mmHg to 135/73 mmHg (16/11 mmHg, p < = 0.047/p < = 0.000), during awake period from 154/87 mmHg to 137/76 mmHg (p < = 0.001/p < = 0.030) and during sleep from 136/72 mmHg to 131/68 mmHg (NS/NS). During 2nd ABPM adequate blood pressure control was achieved in 35% of patients. Systolic blood pressure control improved from initial 4% of patients to 39% and for diastolic blood pressure from 43% to 74%, respectively. Conclusions: Intensive triple fixed dose antihypertensive drug combination, with prescription of additional antihypertensive drug groups when necessary, is effective way to simplify and improve control of resistant hypertension. Although blood pressure in our group of patients was significantly reduced, adequate blood pressure control still wasn’t achieved in a majority of patients.

Sex differences in spontaneous reports on adverse drug events for common antihypertensive drugs

PurposeTo explore sex differences in spontaneously reported adverse drug events (ADEs) for antihypertensives in routine care.MethodsA cross sectional analysis combining number of reports from the national pharmacovigilance database with data from the Swedish Prescribed Drug Register, from 2005 to 2012 for ACE inhibitors (ACE-I) and angiotensin receptor blockers (ARB), with or without thiazide, diuretics (thiazides, potassium-sparing agents, sulfonamides, aldosterone antagonists), selective betablockers, and dihydropyridine calcium-channel-blockers (DHPs). The total number of reports was adjusted to exposed patients and dispensed DDDs among women and men. Dose exposures, co-medications, and co-prescriptions were also analyzed.ResultsIn women, a higher prevalence of ADE-reports was seen in ACE-I (odds ratio, OR 1.21; 95% CI 1.09–1.35), ACE-I-combinations (OR 1.61; 1.44–1.79), ARB-combinations (OR 2.12; 1.47–3.06), thiazides (OR 1.78; 1.33–2.39), diuretics and potassium-sparing agents (OR 1.62; 1.22–2.17), and DHPs (OR 1.40; 1.17–1.67), with a potential linkage to dose exposure. For aldosterone antagonists, we observed a higher prevalence of ADE reports in men (OR 0.75; 0.59–0.97) but without any sex difference in dose exposure.ConclusionsThis ecological study of reported ADEs showed a higher prevalence of reports in women in six out of ten groups of antihypertensive drugs, and this may potentially be linked to dose exposure. Aldosterone antagonists was the only group with a higher prevalence of ADE-reports in men with a similar dose exposure between women and men.

Effects of Long- and Intermediate-Acting Dihydropyridine Calcium Channel Blockers in Hypertension: A Systematic Review and Meta-Analysis of 18 Prospective, Randomized, Actively Controlled Trials.

Dihydropyridine calcium channel blockers are a heterogeneous group of antihypertensive drugs. Long-acting dihydropyridine agent amlodipine is widely used for monotherapy and combination therapy for hypertension in clinical practice, while intermediate-acting dihydropyridine agents have shown inconsistent results in randomized clinical trials (RCTs). A meta-analysis of 18 RCTs enrolling a total of 80,483 patients with hypertension followed for a mean of 51.4 months was performed. Amlodipine therapy was associated with 25% higher risk of heart failure (relative risk [RR]: 1.25, 95% confidence interval [CI], 1.05-1.49, P = .019) but 17% lower risk of stroke (RR: 0.83, [95% CI, 0.72-0.97], P = .009) without statistically significant effect on acute myocardial infarction (AMI) compared to major alternative antihypertensive therapy (MAAT), including β-blocker, diuretic, angiotensin-converting enzyme inhibitor, or angiotensin-receptor blocker. Intermediate-acting dihydropyridine calcium channel blocker therapy was associated with 25% higher risk of heart failure (RR: 1.25, [95% CI, 1.06-1.47], 0.005, P = .005) and 26% higher risk of AMI (RR: 1.26, [95% CI, 1.05-1.51], 0.019, P = .019) compared to MAAT. Results of the subgroup analysis suggested that the intermediate-acting dihydropyridine calcium channel blocker was associated with higher risk of heart failure (RR: 1.30, [95% CI, 1.08-1.56], P = .005) and AMI (RR: 1.50, [95% CI, 1.01-2.22], P = .043) compared to renin-angiotensin system blockers and a trend toward higher risk of AMI (RR: 1.17, [95% CI, 0.99-1.38], P = .064) compared to conventional therapy, including β-blockers and diuretics. Meta-regression analyses suggested that long-acting dihydropyridine calcium channel blocker is associated with lower risk of AMI ( B: -0.327, [95% CI, -0.530 to -0.123], P = .002) with a trend toward lower risk of stroke ( B: -0.203, [95% CI, -0.410 to 0.003] P = .054). This study suggests that Amlodipine offers greater protection against major complications of hypertension compared to intermediate-acting dihydropyridine calcium channel blockers.

Antisense oligonucleotides for the arterial hypertension mechanisms study and therapy

Arterial hypertension is one of the most common chronic diseases in adults all over the world. This pathology can not only reduce patients’ life quality, but can also be accompanied by a number of complications. Despite the fact that there is a large group of antihypertensive drugs on the market, mainly representing different combinations of inhibitors of the renin-angiotensin system, adrenoreceptor blockers in combination with diuretics, there is no generally accepted “gold standard” for drugs that would not have side effects. The review discusses the main aspects of antisense oligonucleotides use in the context of arterial hypertension. It is well known that the medical implementation of antisense oligonucleotides aims to block the expression of particular genes involved in the pathology development, and a key advantage of this technique is a high selectivity of the effect. However, with the undoubted advantages of the method, there are difficulties in its application, related both to the properties of the oligonucleotides themselves (insufficient stability and poor penetration into cells), and to the variety of mechanisms of the origin of a particular pathology, arterial hypertension, in our case. The review provides a brief description of the main molecular targets for antisense treatment of hypertensive disease. The newest targets for therapy with oligonucleotides – microRNAs – are discussed. The main modifications of antisense nucleotides, designed to increase the duration of their effects and simplify the delivery of this type of drugs to the targets are discussed, in particular, combining antisense oligonucleotides with adenovirus-based expression vectors. Particular attention is given to antisense oligonucleotides in the complex with nanoparticles. The review discusses the results of the use of titanium dioxide (TiO2) containing antisense nanocomposites for the angiotensin converting enzyme in rats with stress induced arterial hypertension (ISIAH). It was shown that the use of antisense oligonucleotides continues to be a promising technique for studying the mechanisms of various forms of hypertensive disease and has a high potential for therapeutic use.

A study of prescribing pattern of antihypertensive drugs in hypertensive patients with co morbid diabetes in a tertiary care teaching hospital

Background: Hypertension and diabetes mellitus are among the commonest non-communicable diseases. Co-existence of hypertension and diabetes increases morbidity and mortality. So co-existence of these diseases requires attention and rational management. Studying current prescribing pattern of drugs provide data for recommendations and decisions regarding rational practice. We undertook this study to study prescribing pattern.Methods: It was cross sectional, observational, descriptive study in outdoor patients suffering from hypertension and type 2 diabetes mellitus for duration of one year. Data of 601 patients were analyzed using descriptive statistics to determine prescribing pattern of drugs.Results: In this study, 71.55% patients were above 50 years age. Female patients were 56.57%. Average duration of hypertension was 4.08 years. Commonly prescribed antihypertensive drug groups were angiotensin converting enzyme (ACE) inhibitors (85.36%) followed by β receptor blockers (33.44%) and calcium channel blockers (29.95%). Enalapril (85.36%) followed by amlodipine (29.95%) and atenolol (21.46%) were commonly prescribed antihypertensive drugs. Single antihypertensive drug was prescribed in 292 (48.59%) prescriptions. The most common monotherapy drug was enalapril (82.19%). Two antihypertensive drugs were prescribed in 231 (38.43%) prescriptions. The most common two drug combination was ACE inhibitors + β receptor blockers (40.69%). Four antihypertensive drugs were prescribed in only 1.50% prescriptions.Conclusions: From this study, the results suggest that the prescribing pattern of antihypertensive drugs reflects recommendations of current guidelines and practices. However, β receptor blockers were prescribed more commonly. There is room for improvement in choice of drugs.

Abstract P480: Effects Of Long And Intermediate Acting Dihydropyridine Calcium Channel Blockers In Hypertension: A Systematic Review And Aeta-analysis Of 18 Prospective, Actively Controlled, Randomized Clinical Trials

Background: Dihydropyridine calcium channel blockers are a heterogeneous group of antihypertensive drugs. Long acting dihydropyridine agent Amlodipine is widely used for mono and combination therapy for hypertension in clinical practice, while intermediate acting dihydropyridine agents such as Felodipine, Nifedipine-GITS etc. have shown inconsistent results in randomized clinical trials (RCTs). Methods and Results: A meta-analysis of 18 prospective, actively controlled RCTs enrolling a total of 80,069 hypertensive patients followed for a mean of 51.7 months was performed. Amlodipine therapy was associated with 24% higher risk of heart failure (RR: 1.24, [95%CI: 1.04 to 1.48], p= 0.019) but 16% lower risk of stroke (RR: 0.84, [95%CI: 0.73 to 0.95], p=0.009) without statistically significant effect on acute myocardial infarction (AMI) (RR: 0.90, [95%CI: 0.78 to 1.03], p=0.128) or cardiovascular event (CVE) (RR: 0.99, [95%CI: 0.93 to 1.06], p=0.814). Intermediate acting dihydropyridine calcium channel blocker therapy was associated with 24% higher risk of heart failure (RR: 1.24, [95%CI: 1.07 to 1.44], p=0.005), 27% higher risk of AMI (RR: 1.27, [95%CI: 1.04 to 1.55], p=0.019), 14% higher risk of CVE (RR: 1.14, [95%CI: 1.01 to 1.29], p=0.034) without statistically significant effect against stroke (RR: 1.03, [95%CI: 0.87 to 1.21], p=0.580). Amlodipine showed higher risk of heart failure (RR: 1.20, [95%CI: 1.00 to 1.43], p=0.045) and lower risk of stroke (RR; 0.85, [95%CI: 0.75 to 0.96], p= 0.007) compared to Renin-angiotensin-system (RAS) blockers. Intermediate acting dihydropyridine calcium channel blocker showed higher risk of heart failure (RR: 1.31, [95%CI: 1.09 to 1.57], p=0.004) and AMI (RR: 1.46, [95%CI: 1.00 to 2.14], p=0.050) compared to RAS blockers. Multivariate meta-regression suggested that the effect size may differ between intermediate and long acting agents for stroke (B: -0.27, [95%CI: -0.50 to -0.05], p=0.012) and AMI (B: -0.42, [95%CI: -0.69 to -0.16], p=0.002) after adjustment for baseline presence of diabetes. Conclusions: This study suggests that Amlodipine offers greater protection against major complications of hypertension compared to intermediate acting dihydropyridine calcium channel blockers.

Effects of different antihypertensive medication groups on cognitive function in older patients: A systematic review

BackgroundChronic hypertension has been associated with an increased risk of cognitive decline. Although a link between hypertension and cognitive decline has been established, there is less evidence supported by systematic reviews. The main aim was to compare different antihypertensive drug groups in relation to their effect on cognition in older patients without established dementia using a systematic review. MethodA systematic search in Medline and Embase through to January 2017 was used to identify randomized controlled clinical trials (RCTs) studying the impact of different antihypertensives on cognition in older patients without dementia. Angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACE-Is), beta-blockers (BBs), diuretics, and calcium channel blockers (CCBs) were included in this review. ResultsThe systematic search identified 358 studies. The full text of 31 RCTs was reviewed and a total of 15 RCTs were included in the review. Most studies reported an improvement in episodic memory in patients treated with ARBs versus placebo or other types of antihypertensive drugs. No study showed an improvement in cognition in patients who received diuretics, BBs, or CCBs. Heterogeneity was high in most trials (predominantly in the blinding of participants and investigators). ConclusionThis review suggests that ARBs can improve cognitive functions in the elderly, especially episodic memory. ACE-Is, diuretics, BBs and CCBs did not seem to improve cognitive function in the elderly but were similarly effective in blood pressure lowering as ARBs.

A prospective study of various anti hypertensive drugs on reversal of left ventricular hypertrophy in hypertensive Bangladeshi population

Regression of ventricular hypertrophy is the restoration of normal ventricular structure and physiology after the hypertrophy has developed. It has been clearly demonstrated that once left ventricular hypertrophy (LVH) is diagnosed, it represents a strong blood pressure independent risk factor for cardiovascular morbidity and mortality.This prospective observational study was carried out in Department of Cardiology, BSMMU, Dhaka to compare the effectiveness of different anti-hypertensive agents in reducing left ventricular hypertrophy (LVH) in hypertensive Bangladeshi population involving 95 patients with clinically diagnosed hypertension. The duration of study was from July 2005 to Tune 2008. Out of these 95 patients, 20 were included in beta-blocker(BB) group, 14 in angiotensin converting enzyme inhibitor(ACEi) group, 20 in beta-blocker(BB) + diuretic(DD) group, 14 in angiotensin converting enzyme inhibitor(ACEi) + diuretics(DD) group, 13 in beta-blocker(BB) and angiotensin enzyme inhibitor(ACEi) group and 14 in beta-blocker(BB) + angiotensin converting enzyme inhibitor(ACEi) + diuretic(DD) group. patients were followed-up at 8 weeks, 6 months, 1 year and at 2 years. A baseline M-mode echocardiography was done to document LVH. Among three groups of anti-hypertensive drugs, angiotensin converting enzyme inhibitor alone has been found to be most effective as compared to beta blockers when used alone than in combination groups (Beta blocker plus ACEi plus Diuretics or Beta blocker plus ACEi). Although, statistically not significant, a clear benefit has been shown in all groups in terms of LVH regression.Bangladesh Med J. 2016 Sep; 45 (3): 156-159

Sex Differences in Spontaneous Reports on Adverse Drug Events for Antihypertensive Drugs

In general, few data exist regarding sex differences in spontaneous adverse drug event (ADE) reporting. We wanted to explore if sex differences are found in spontaneously reported adverse drug events for antihypertensive drug treatment in routine care. A cross sectional analysis combining number of reports for ten groups of antihypertensive drugs; ACE inhibitors (ACE-I), with or without thiazide combinations, angiotensin receptor blockers (ARB), with or without thiazide combinations, diuretics (thiazides, potassium-sparing agents, sulfonamides, aldosterone antagonists), selective betablockers and dihydropyridine calcium channel blockers (DHPs), from the national pharmacovigilance database with data from the Swedish Prescribed Drug Register, from 2005 to 2012. The total number of reports was adjusted to the number of exposed patients and the number of dispensed DDDs, respectively, among women and men (ORs with 95% CI). The most frequently reported ADEs were collected and co-medication and co-prescription were analysed. In women, a higher prevalence of ADE reports was seen in six of the ten groups of antihypertensive drugs: ACE-I (OR 1.21; 1.09-1.35) ACE-I with combinations (OR 1.61; 1.44-1.79), ARB with combinations (OR 2.12; 1.47-3.06), thiazides (OR 1.78; 1.33-2.39), diuretics and potassium sparing agents (OR 1.62; 1.22-2.17) and DHPs (OR 1.40; 1.17-1.67). For aldosterone antagonists, we observed a higher prevalence of ADE reports in men (OR 0.75; 0.59-0.97). One of the most frequently reported events found in several subgroups were hyponatremia. This diagnosis also had a very high overrepresentation in women. This ecological study of reported ADEs due to antihypertensive treatment showed a higher prevalence of reports in women in six out of ten groups of antihypertensive drugs. The only group of antihypertensive agents with a higher prevalence of ADE reports in men was aldosterone antagonists.

Comparison of the effect of treatment with the main groups of antihypertensive drugs on the quality of life in patients with stable arterial hypertension

When appointing antihypertensive drugs to patients with stable mild to moderate arterial hypertension (AH) it is necessary to take into account the effect of treatment on the quality of life (QoL) of these patients. The aim of the study was to compare the effect of prolonged use of antihypertensive drugs from the main treatment groups on QoL of patients with stable AH in 5 controlled trials. The results of monotherapy efficacy were assessed by 24-hour blood pressure monitoring and QoL patients were studied before and after long-term monotherapy according to the results of a database analysis of 5 studies performed in our center for the last 4 years. After the period of withdrawal of antihypertensive therapy, patients underwent 24-hour blood pressure monitoring, QoL was evaluated. According to 24-hour blood pressure monitoring, diltiazem had an antihypertensive effect, comparable to the effect of enalapril. Both drugs had no effect on the circadian rhythm of arterial pressure and the outpatient heart rate. Long-term use of none of the antihypertensive drugs (diltiazem, amlodipine, enalapril, metoprolol, telmisartan) did not worsen QoL. The greatest impact on QoL was provided by the group of angiotensin-converting enzyme inhibitors, enalapril, significantly improving QoL.

Hypertensive urgency or high blood pressure variability?

Hypertensive urgency (HU) is a common reason particularly for elderly patients to seek medical advice. Severe asymptomatic hypertension and situational high blood pressure (BP) in patients with its high variability is frequently taken as HU. The use of short-acting antihypertensive drugs is not only indicated in these situations, but it may also increase the risk of cardiovascular events (CVE). Over the past decade, increased BP variability is an independent predictor for a higher risk of CVE. Among the major groups of antihypertensive drugs, there are calcium antagonists, mainly amlodipine, which has the greatest potential to reduce BP variability. Thus, calcium antagonists can be considered as first-line drugs for patients with high BP variability.

Choice of treatment based on Turkish hypertension consensus report: Do we follow the recommendations?

The aim of this study was to determine how often the recommendations of the Turkish Hypertension Consensus Report are followed, and to draw attention to the report. The demographic information of 1000 patients diagnosed with hypertension and the details of the antihypertensive medications prescribed at the outpatient service of a tertiary care hospital were recorded, and the data were compared with the recommendations of the report. The mean age of the patients was 62±11 years. In all, 623 (62.3%) of the 1000 patients were women, and 377 (37.7%) were men. A combination of an angiotensin II receptor blocker (ARB) and a diuretic was the most frequently observed prescription. A diuretic was the most used antihypertensive drug (58.7%), followed by an ARB (48.8%). However, as a monotherapy, a calcium channel blocker (CCB) was the most commonly used antihypertensive drug (19.2%). The most frequently used antihypertensive drug group in older patients was diuretics (63.6%), as proposed in the report. Beta blockers (49.1%) were used more often than expected. For the diabetic group also, a diuretic (60.7%) was the most frequently used antihypertensive drug, followed by an ARB (51.1%) and a CCB (45.2%). Angiotensin-converting enzyme (ACE) inhibitors (34.6%) were the fifth most preferred antihypertensive drug class. However, when ACE inhibitors and ARBs were considered as a single group, known as renin-angiotensin system (RAS) blockers, these RAS blockers were the most prescribed antihypertensive drug class, followed by diuretics. In the group of patients with coronary artery disease, treatment was found to be generally consistent with the report, but the use of diuretics was greater than expected. Lastly, 124 of 160 patients who had chronic kidney disease were given RAS blocker therapy, which was in line with the consensus report recommendations. Antihypertensive therapies were individualized, as suggested by the consensus report. However, there are proposals still to be considered in special patient groups.

COMBINED ANTIHYPERTENSIVE THERAPY IN REAL CLINICAL PRACTICE. FOCUS ON FIXED COMBINATIONS OF ANTIHYPERTENSIVE DRUGS (According to the Data of Outpatient Registries RECVASA and PROFILE)

On Behalf of the Working Groups of the Registries PROFILE and RE С VASA. Working Group of the PROFILE Registry : Akimova A.V., Voronina V.P., Dmitrieva N.A., Zakharova A.V., Zakharova N.A., Zagrebelnyy A.V., Kutishenko N.P., Lerman O.V., Lukina Yu.V., Tolpygina S.N., Martsevich S.Y. Working Group of the RECVASA Registry : Vorobyev A.N., Zagrebelnyy A.V., Kozminsky A.N., Lukina Yu.V., Loukianov M.M., Moseichuk K.A., Nikulina N.N., Pereverzeva K.G., Pravkina E.A., Boytsov S.A., Martsevich S.Yu., Yakushin S.S. Aim. To assess the frequency of prescription of different combinations of the main groups of antihypertensive drugs (AHD) and their fixed combinations to patients with arterial hypertension by physicians according to two outpatient registries. Material and methods . Hypertension was diagnosed in 3648 (98.9%) patients of the RECVASA registry and in 1230 patients of the PROFILE registry (80.3%). Data on doctor’s prescriptions reflected in the outpatient charts of patients of the both registries were analyzed. The following information of the prescribed antihypertensive therapy was studied in details: AHD, including fixed and free combinations, original and generic AHD. Data on the achievement/non-achievement of target blood pressure (BP) level in patients with hypertension were also analyzed. Results. Women were predominated among hypertensive patients of the RECVASA registry, (71.9%). The ratio of men and women was close to 1:1 in the PROFILE registry. Patients of the registry RECVASA were older: the average age was 66.2±12.8 years compared to 63.7±11.4 years in patients of the PROFILE registry, respectively. The majority of patients in the RECVASA registry (61.4%) had hypertension of the 3rd degree, patients of the PROFILE registry revealed mostly hypertension of the 2 degree (53.3%). Fixed combinations were prescribed to 14% of patients in the registry of RECVASA and to 16% of patients in the PROFILE registry. Doctors of the PROFILE registry often prescribed original AHD; 75% of patients from RECVASA registry received generics. The most popular combinations in both registries were combinations of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers with thiazide/thiazide-like diuretics. The target level of BP was more often achieved in the patients of the PROFILE registry: 37.6% vs 26.1% in the RECVASA registry. Conclusion . The results of the analysis of the presented registries demonstrate the low frequency of prescribing fixed combinations in real clinical practice, the inertness of physicians in achieving the target BP levels and the low efficiency of antihypertensive therapy.

What drugs do hypertension patients take in clinical practice? Structure of antihypertensive drugs in a large siberian region

Objective. To assess the frequency of prescribing of different groups of antihypertensive drugs (AHD) in the treatment of patients with arterial hypertension (AH) among patients of the Krasnoyarsk territory according to the Russian epidemiological studies ESSE-RF. Materials and methods. 1,603 persons aged 25–64 years, selected through systematic stratified multistage randomization among the population attached to the four outpatient clinics of Krasnoyarsk and Berezovsky district hospital were studied. All included subjects were subjected to a detailed survey of office blood pressure measurements. Results. The proportion of those on monotherapy was 53.4%. The most commonly accepted AHD, including in the combination therapy, were angiotensin-converting enzyme inhibitors (ACEI) – in 51% of cases, beta-blockers – 28.9 percent, angiotensin receptor blockers (ARBS) – 25,2%, diuretics – 23,2%, calcium channel blockers (CCB) – 11.9%, central action drugs – 2.0% and alpha-blockers – 0.4 percent. Beta-blockers often were taken by those of younger age – 38.1 per cent, mainly men aged 25–34 years (50.0 per cent). Among the combinations of AHD the most frequently encountered combination was ACEI + diuretic (6,8%), followed by rthe frequency of prescription by ARBS + diuretic, beta-blocker + diuretics, ARBS + CCB, ACE-I + CCB. Conclusion. The frequent prescription of ACE inhibitors and insignificant use of central action is noted. The high level of violence of use of AHD monotherapy in patients with hypertension (53,4%) is alarming, which may be one of the reason for the relatively low efficiency of antihypertensive therapy (31.6 percent). Beta-blockers were indicated unreasonably often for young men with hypertension aged 25–34 years.

Analysis of the antihypertensive drugs prescription on the outpatient level

Aim of the study was to explore the choice of antihypertensive drugs by doctors therapists of ambulatory and outpatient units based on medical and sociological research.Methods. Sociological (questionnaire), statistical, mathematical.Results. Among the groups of antihypertensive drugs most commonly prescribed antihypertensive drugs I-grade (answered the question «OFTEN»): diuretics (82.5%), ACE inhibitors (75.5%), β-blockers (68.6%) and calcium antagonists of long action (67.3%), which meets the recommendations of the Ukrainian Association of Cardiologists.Conclusions. The first choice of antihypertensive drugs for hypertension treatment by physicians of ambulatory and outpatient units was studied.

ДОСЛІДЖЕННЯ АСОРТИМЕНТУ АНТИГІПЕРТЕНЗИВНИХ ПРЕПАРАТІВ, ЩО ПРЕДСТАВЛЕНІ НА ФАРМАЦЕВТИЧНИХ РИНКАХ УКРАЇНИ ТА ПОЛЬЩІ

&lt;h2&gt;RESEARCH OF ANTIHYPERTENSIVE MEDICINESʼ ASSORTMENT WHICH ARE PRESENTED IN PHARMACEUTICAL MARKETS OFUKRAINEANDPOLAND&lt;/h2&gt;&lt;h2&gt;N.Yu. Poluychak, M.B. Demchuk, O.О. Yurуeva&lt;sup&gt;1&lt;/sup&gt;, T.A. Groshovyi,&lt;/h2&gt;&lt;h2&gt;SHEI «TernopilStateMedicalUniversityby I.Ya. Horbachevsky»&lt;/h2&gt;&lt;h2&gt;&lt;sup&gt;1&lt;/sup&gt;JSC «Farmak»&lt;/h2&gt;&lt;h2&gt;Summary. The article analyzes the antihypertensive medicinesʼ assortment which is presented in the pharmaceutical markets ofUkraineandPoland. Assortment policies of pharmaceutical manufacturers of antihypertensive drugs, diuretics, b-adrenergic blockers, calcium antagonists, drugs that affect the renin-angiotensin system are analyzed.&lt;/h2&gt;&lt;h2&gt;Key words: hypertension, pharmaceutical market ofUkraine, pharmaceutical market ofPoland, antihypertensive medicines.&lt;/h2&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction. &lt;/strong&gt;Diseases of the cardiovascular system (CAS) are the leader in the structure of morbidity and mortality in the adult population of highly developed countries. Among pathology of CAS the most common is arterial hypertension (AH), which is found in 15-20% of adults in industrialized countries and is recognized as a chronic no communicable disease. Despite the global nature of the prevalence of hypertension, certain regions of the world differ greatly on this indicator. AG has acquired a large spread in the European Region.&lt;/p&gt;&lt;p&gt; All classes of antihypertensive agents recommended by the European Society of Cardiology and the Society for AH (2003), US Joint National Committee (7th revision, 2003) and Ukrainian Society of Cardiology (2004) as first-line drugs in the treatment of hypertension, almost equally reduce blood pressure. It is well known that such pharmacological groups that can be used as part of a monotherapy and in combination therapy include the following drugs: diuretics; angiotensin-converting enzyme (ACE) inhibitors; calcium channel blockers; angiotensin II receptor antagonists; β-blockers. The group of second-line drugs is forming alpha 1-blockers; Rauvolfia alkaloids; central α2-agonists; imidazoline receptor agonist drugs.&lt;/p&gt;&lt;p&gt; The purpose of this study is to&lt;strong&gt; &lt;/strong&gt;study the assortment medicines for the treatment of hypertension, which are available to consumers onUkraine by comparison with an assortment of antihypertensive drugs, which are represented in the pharmaceutical market inPoland.&lt;/p&gt;&lt;p&gt; &lt;strong&gt;Methods.&lt;/strong&gt; Analysis of the assortment of drugs that are presented in the domestic pharmaceutical market conducted under Ukrainian State Register of medicines. For the study of current state of the Polish market of antihypertensive agents, the Polish State Register of medicines and official website http://pharmindex.pl, http://leki-informacje.pl., is applied.&lt;/p&gt;&lt;p&gt; &lt;strong&gt;Results and discussion&lt;/strong&gt;. According to the State Register of medicines ofUkraine by January2015, a group of antihypertensive drugs consists of more than 790 drugs. The antihypertensive agentsʼ group represented more than 940 drugs on the Polish pharmaceutical market. According to ATC - classification analyzed following groups: C02 - antihypertensive drugs, C03 - diuretics, C07 - beta blocking agents, C08 - calcium channel blockers, C09 - agents acting on the renin-angiotensin system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions. &lt;/strong&gt;The majority of medicines, which are offered on the European markets, are represented in domestic market. The exclusions are the medicines, which contain clopamide, chlortalidone, canreon – from the diuretics group, pindolol and acetebulol – from the β-blockers group, isradipine – from the group of calcium channel blockers, benazepril, cilazapril, trandolapril and imidapril – from angiotensin-converting-enzyme inhibitors group. Assortment of antihypertensive medicines in the market of Poland is represented by combined medicines of benazepril with diuretics, cilazapril with diuretics, ramipril with felodipine, aliskiren with amlodipine, which are absent on the domestic market.&lt;/p&gt;

LB01.03

Objective: Recent observational studies have shown varied association between antihypertensive drugs and digoxin with either cancer risk or prognosis. We studied the time to incident cancer in two large patient cohorts in relation to four antihypertensive drugs and digoxin. Design and method: We studied a hospital admission based cohort of 525,046 patients admitted at least once to the Western Infirmary and Gartnavel hospitals between 1980 and March 2013. Patients were classified into 6 mutually exclusive groups based on monotherapy with either ACEI/ARB(AA), beta-blockers(BB), calcium antagonist(CCB), thiazides, digoxin and a control group without exposure to these drugs. All control subjects were included if they were not on the any of the above drugs and were aged 60–80 years at 1/4/2004. The inclusion criteria for the drug groups included new prescription of the drug after 1/4/2004, no previous prescription of any of the study drug, at least 90 days of prescription, discontinuation of the drug no later than 1 year before onset of cancer. Each of the 4 antihypertensive drug groups were mutually exclusive for any prescription for the other drugs while the digoxin group included all subjects exposed to digoxin. Age and sex adjusted time to first cancer diagnosis and time to death from cancer diagnosis were performed. Results: 34,634 subjects fulfilled the inclusion criteria and of them 6,153 had a new diagnosis of cancer after 1/4/2004. During 8-year period follow-up 6,557 patients were diagnosed with cancer in the hospital cohort (2,313 gastrointestinal, 2,439 lung, 464 prostate, 321 breast cancers). The results of the multivariate adjusted Cox model for incident cancer are presented in Figure 1. Conclusions: Exposure to digoxin or beta-blocker therapy appears to be protective against incident respiratory cancers while CCB increased risk. Thiazides are associated with increased GIT cancers. CCB use at diagnosis of breast cancer improved survival.

The association of arterial hypertension and ischemic heart disease is the main problem in modern cardiology practice

This article deals with the epidemiological datashowing higher frequency of arterial hypertension (AH) in patients with ischemic heart disease (IHD). We discussed the basic characteristics of modern domestic and foreign recommendations for treating patients with combination of AH and IHD. We showed the target of blood pressure (BP) in this category of patients. This article deals with the priority groups of antihypertensive drugs, which have the advantages in the combination usage in patients with association of these diseases. We fixed special attention to the problem of BP variability (BPV) as a new risk factor for the development of coronary complications in patients with AH. We showed the possibility of fixed combination of perindopril and amlodipine in reducing interand intervisit BPV in patients with AH and IHD in actual clinical practice.