[Current status of antihypertensive drug treatment in primary care practice at launch of the new renin inhibitor aliskiren (RASANT)].
OBJECTIVE
The present drug utilization research project was conducted in order to evaluate the current status of antihypertensive drug treatment at launch of aliskiren - a drug targeting a completely new pharmacological mode of action - and to investigate the potential therapeutic value of this new therapeutic principle.


METHODS
In 1,431 primary care practices in Germany, general practitioners and internal specialists were requested to determine the therapeutic value of different antihypertensive drugs (3rd and 4th quarter of 2007). Physicians were also requested to expose potential advantages of the new therapeutic principle of direct renin inhibition. Additional epidemiologic data such as age, gender and comorbidities were collected for each antihypertensive patient considered an optimal candidate to receive aliskiren in the respective medical practice due to an unfavorable response to the current antihypertensive treatment by using a second questionnaire.


RESULTS
On a scale between 1 (very important) and 6 (unimportant), the therapeutic value of antihypertensive drugs was judged as follows: angiotensin-inhibiting enzyme (ACE) inhibitors (98.8%), angiotensin (AT)(1) receptor blockers (87.4%), beta-receptor blockers (71.2%), calcium channel blockers (58.9%), thiazide diuretics (56,3%), and loop diuretics (32.3%) were judged with the mark 1 (very important) and 2 (important). From a total of 14,358 patients included in the present survey, age, gender, severity and duration of arterial hypertension, complications and comorbidities, and a detailed drug history were collected. 50.3% of the patients received an ACE inhibitor, 27.9% an AT(1) receptor blocker, 45.7% a beta-receptor blocker, 37.5% a calcium channel blocker, and 53.2% a diuretic. Dominating comorbidities up to the time of data collection were diabetes mellitus (43.8%), coronary heart disease (37.3%), and chronic heart failure (20.7%). 89.4% of patients with diabetes received either an ACE inhibitor or an AT(1) receptor blocker compared to 69.6% of patients not suffering from diabetes.


CONCLUSIONS
According to the evaluation of primary care physicians participating in this study, aliskiren might be useful for antihypertensive treatment in patients with severe arterial hypertension, in patients with an already long-lasting course of disease, and in the presence of comorbidities such as diabetes mellitus. The high percentage of patients in this study cohort already treated with an ACE inhibitor or an AT(1) receptor blocker represents good adherence of primary care physicians to current treatment guidelines. The evaluation of loop diuretics as important antihypertensive drugs by 32.3% of attending physicians in this study requires critical discussion.
Müller
Axel
A
Klinik für Innere Medizin I der Klinikum Chemnitz gGmbH, Chemnitz. axel.mueller@skc.de
Schweizer
Johannes
J
Kirch
Wilhelm
W
Schindler
Christoph
C
D000328:Adult; D000368:Aged; D000577:Amides / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015897:Comorbidity; D017277:Drug Approval; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005650:Fumarates / Q000009:adverse effects / Q000627:therapeutic use*; D005858:Germany; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care; D016896:Treatment Outcome; D000092502:Renin Inhibitors
D000577:Amides; D000959:Antihypertensive Agents; D005650:Fumarates; D000092502:Renin Inhibitors; C446481:aliskiren