How are physicians prescribing the direct renin inhibitor aliskiren in the management of essential hypertension? A French observational study

Sosner, P.; Fiquet, B.; Quéré, Stéphane; Francillon, A; Herpin, D.

doi:10.1097/hjh.0b013e328360f716

Cited by 2 publications

(2 citation statements)

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“…Our finding of low rates of adoption of direct renin inhibitors is consistent with studies of the use of these agents outside of the United States [22]. Despite representing a novel mechanism of action, there are many factors that influence the clinical adoption of a new therapy after market debut, including the number of therapies currently available on the market, as well as their safety, tolerability and level of marketing and promotion [23].…”

Section: Discussionsupporting

confidence: 78%

National Trends in the Ambulatory Treatment of Hypertension in the United States, 1997-2012

et al. 2015

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ImportanceHypertension is common and costly. Over the past decade, new antihypertensive therapies have been developed, several have lost patent protection and additional evidence regarding the safety and effectiveness of these agents has accrued.ObjectiveTo examine trends in the use of antihypertensive therapies in the United States between 1997 and 2012.Design, Setting and ParticipantsWe used nationally representative audit data from the IMS Health National Disease and Therapeutic Index to examine the ambulatory pharmacologic treatment of hypertension.Outcome MeasuresOur primary unit of analysis was a visit where hypertension was a reported diagnosis and treated with a pharmacotherapy (treatment visit). We restricted analyses to the use of six therapeutic classes of antihypertensive medications among individuals 18 years or older.ResultsAnnual hypertension treatment visits increased from 56.9 million treatment visits (95% confidence intervals [CI], 53.9–59.8) in 1997 to 83.3 million visits (CI 79.2–87.3) in 2008, then declined steadily to 70.9 million visits (CI 66.7–75.0) by 2012. Angiotensin receptor blocker utilization increased substantially from 3% of treatment visits in 1997 to 18% by 2012, whereas calcium channel blocker use decreased from 27% to 18% of visits. Rates of diuretic and beta-blocker use remained stable and represented 24%–30% and 14–16% of visits, respectively. Use of direct renin inhibitor accounted for fewer than 2% of annual visits. The proportion of visits treated using fixed-dose combination therapies increased from 28% to 37% of visits.ConclusionsSeveral important changes have occurred in the landscape of antihypertensive treatment in the United States during the past decade. Despite their novel mechanism of action, the adoption rate of direct renin inhibitors remains low.

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Section: Discussionsupporting

confidence: 78%

National Trends in the Ambulatory Treatment of Hypertension in the United States, 1997-2012

et al. 2015

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“…However, escape phenomenon is considered the most important cause for limitation of clinical efficacy of antihypertensive drugs that suppressed RAS [4]. The appearance of direct renin inhibitors, such as aliskiren, that are contributing to reduced secretion of angiotensin-2, were seen as a possible way to achieve more complete control of the activity of RAS and overcoming «escape phenomenon» [5,6]. It is assumed that beta-blockers can significantly enhance the antihypertensive potenrtsial aliskiren [7].…”

mentioning

confidence: 99%

Interfering of antihypertensive effect of Aliskiren and Nebivolol combination with Renin-Angiotensin and sympatic systems suppression

Nalotova¹

2014

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The objective of the study was to compare efficacy of aliskiren alone, nebivolol alone, and aliskiren and nebivolol in combination in essential hypertension patients. Methods: The study evolved 123 patients (68 males) aged 48 to 62 years with moderate-to-severe arterial hypertension. Aliskirten alone was prescribed for 41 subjects in daily doses 150-300 mg orally (1str group). Nebivolol was given for 50 Olga S. Nalotova 2 nd group patients in 5-10 mg daily orally, and combined therapy with both drug (aliskiren 150 mg daily and nebivolol 5 mg daily orally) was prescribed for 43 subjects (3 rd group). Office blood pressure, heart rate was measured at baseline and in1 weeks during 8 weeks of observation period. Blood sampling for further biochemical and biomarkers measurements was obtained at baseline and in 8 weeks. Twenty hours urine norepinephrine excretion was examined by column chromatography methods. Renin activity in plasma and concentration of aldosteron were measured by IFA method. Results: All patients have achieved a target level of blood pressure for 8 weeks of observation period. The most effective of pharmacotherapy strategy was a combination of aliskiren and nebivolol that leads reduced systolic and diastolic office blood pressure up 18.8 ± 1.2% and 18.6 ± 0.9%. However, all patients that were treated with drug combination have achieved target level of BP (less 140 / 90 mm Hg) in 2 weeks after baseline. During 8 weeks treatment period SAS and RAS activity was decreased closely in all patient groups. However, combination aliskiren and nebivolol let to overcome hyperactivation of both SAS and RAS In conclusion, combination aliskiren with nebivolol is effective in treating patients with hypertension. The significantly decreased effect on blood pressure found in patients may be attributed to decreased neurohumoral activity of the RAS and SAS

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How are physicians prescribing the direct renin inhibitor aliskiren in the management of essential hypertension? A French observational study

Cited by 2 publications

References 20 publications

National Trends in the Ambulatory Treatment of Hypertension in the United States, 1997-2012

National Trends in the Ambulatory Treatment of Hypertension in the United States, 1997-2012

Interfering of antihypertensive effect of Aliskiren and Nebivolol combination with Renin-Angiotensin and sympatic systems suppression

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