CHOICE OF THE INITIAL TREATMENT FOR MILD TO MODERATE ARTERIAL HYPERTENSION IN MOSCOW PRIMARY PRACTICE

Aim. To assess the choice of initial pharmacotherapy of uncomplicated mild to moderate arterial hypertension (HT) in Moscow primary care as well as to clear up the influence of regulatory measures on this choice.

Material and methods. Results of two similar surveys conducted in 2011-2012 (452 respondents) and 2013-2014 (273 respondents) were compared to estimate preferences of Moscow primary care physicians regarding initial antihypertensive agents for therapy of uncomplicated mild to moderate HT taking into consideration an influence of regulatory requirement to prescribe medicinal products by international nonproprietary name (INN) since July 2012. All participants were proposed to write down their preferred antihypertensive agents for initial mono- or combined therapy of mild to moderate HT with moderate cardiovascular risk and absence of compelling indications.

Results. Angiotensin converting enzyme inhibitors (ACEI) remained the leading class of antihypertensive agents, though their popularity slightly but significantly declined from 44.4% in 2011-12 to 37.2% in 2013-14 (р<0.05). Angiotensin receptor blockers partially displaced the leaders and increased their popularity from 11.3% in 2011-12 to 18.0% in 2013-14 (р<0.01). ACEI/diuretic combination remained on the 3rd position (16.4% and 15.3% respectively). Beta-blockers and diuretics as monotherapy shared 4th and 5th places in this rating. Calcium channel blockers popularity among Moscow prescribers remained unchanged and poor – 2.1%. The most popular medicine by trade name was Noliprel, perindopril/indapamide fixed combination, – 14.0% and 13.7% of respondents in 2011-12 and 2013-14, respectively. The share of medicine products recommended by INN went up from 11.9% to 22.8% among top-10 popular medications (р<0.01).

Conclusion. Blockers of renin-angiotensin-aldosterone system remain the leading drugs for the initial treatment of uncomplicated mild to moderate HT without compelling indications among Moscow primary care physicians. Regulatory requirement to prescribe medicinal products by INN was associated with significant increase in the share of drugs recommended by INN, though this effect was less than expected one.

1. The Demographic Yearbook of Russia 2013. Available at: http://www.gks.ru/bgd/regl/B13_16/Main.htm. Accessed by 04.10.2014. Russian (Демографический ежегодник России 2013. Доступно на: http://www.gks.ru/bgd/regl/B13_16/Main.htm. Проверено: 04.10.2014).

2. Chazova I.E., Ratova L.G., Boytsov S.A., Nebieridze D.V. Recommendations for the management of arterial hypertension Russian Medical Society of Arterial Hypertension and Society of Cardiology of the Russian Federation. Sistemnye Gipertenzii 2010; 3:5-26. Russian (Чазова И.Е., Ратова Л.Г., Бойцов С.А., Небиеридзе Д.В. Диагностика и лечение артериальной гипертензии (Рекомендации Рос-сийского медицинского общества по артериальной гипертонии и Российского научного обще-ства кардиологов). Системные Гипертензии 2010; 3:5-26).

3. The Order of Ministry of Health of Russian Federation No1175н of 20.12.2012 “On approval of the procedure of administration and prescription of drug products, prescription forms and the order of issue, registration and storage of these forms” Russian Gazette Federal Issue 6188 of 03.07.2013. Russian (Приказ МЗ РФ от 20.12.2012 г. №1175н «Об утверждении порядка назначения и выписывания лекарственных препаратов, а также форм рецептурных бланков, порядка оформления этих блан-ков, их учета и хранения». Российская Газета Федеральный выпуск 6188 от 03.07.2013).

4. Feldman R.D., Zou G.Y., Vandervoort M.K. et al. A simplified approach to the treatment of uncomplicated hypertension: a cluster randomized, controlled trial. Hypertension 2009; 53(4):646-53.

5. Ovarnström M., Wettermark B., Ljungman C. et al. Antihypertensive treatment and control in a large primary care population of 21167 patients. J Hum Hypertens 2011; 25(8):484-91.

6. Vasyuk Yu.A., Shkolnik E.L. Beta-blockers for arterial hypertension: the end of the era or just confusing the issue. Trudnyy Patsient 2007; 5(8): 5-8. Russian (Васюк Ю.А., Школьник Е.Л. Бета-блока-торы при артериальной гипертензии: конец эры всего класса или тень на плетень? Трудный Па-циент 2007; 5(8):.5-8).

7. Leonova M.V., Belousov Yu.B., Shteinberg L.L. et al. Farmacoepidemiology of arterial hypertension in Russia (according to the materials of the pharmacoepidemiologic PIFAGOR III study). Rossiyskiy Kardiologicheskiy Zhurnal 2011; 88(2): 9-16. Russian (Леонова М.В., Белоусов Ю.Б., Штейнберг Л.Л. и соавт. Фармакоэпидемиология артериальной гипертонии в России (по материалам фарма-коэпидемиологического исследования ПИФАГОР III). Российский Кардиологический Журнал 2011;.88(2): 9-16).

8. Ubel P.A., Jepson C., Asch D.A. Misperceptions about beta-blockers and diuretics: a national survey of primary care physicians. J Gen Intern Med 2003;18(12):977-83.

9. Christe V., Waeber G., Vollenweider P., Marques-Vidal Pedro. Antihypertensive drug treatment changes in the general population: the CoLaus study. BMC Pharmacol Toxicol 2014; 15:20

10. Wright J.M., Musini V.M. First-line drugs for hypertension. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD001841.

11. Trimarco V., de Simone G., Izzo R. et al. Persistence and adherence to antihypertensive treatment in relation to initial prescription: diuretics versus other classes of antihypertensive drugs. J Hypertens 2012; 30(6): 1225-32.

12. Rochefort C.M., Morlec J., Tamblyn R.M. What differentiates primary care physicians who predominantly prescribe diuretics for treating mild to moderate hypertension from those who do not? A comparative qualitative study. BMC Family Practice 2012; 13:9.