title: How are physicians prescribing the direct renin inhibitor aliskiren in the management of essential hypertension? A French observational study.
abstract: OBJECTIVE
  The aim of this French observational study was to evaluate how the direct renin inhibitor aliskiren is being prescribed to treat hypertension by primary care providers (PCPs) and office-based cardiologists.
  
  
  METHODS
  Each participating physician included the first three consecutive hypertensive patients who had been prescribed aliskiren at least 4 weeks beforehand and noted whether aliskiren was prescribed: alone or as part of a combination; as first-line therapy, to replace another drug or as an add-on therapy.
  
  
  RESULTS
  Five thousand, four hundred and eleven patients were analyzed [mean age, 63; 58% men; 24% diabetic; mean blood pressure (BP) 148/85 mmHg]. A total of 23.6% of patients had a controlled BP. Aliskiren was prescribed alone in 49.4% patients and as part of a combination in 50.6% (bitherapy 28.3%, tritherapy 14.7%, and quadri+therapy 7.6%), at the higher recommended dosage (300 mg daily) to two-thirds of cases. Aliskiren replaced another drug in 71.9% [mainly an angiotensin receptor blocker (ARB) or an angiotensin-converting enzyme inhibitor (ACEi)] and was added to an existing regimen in 22.5%. For bitherapy, aliskiren was combined with a diuretic (D; 39%) or a calcium channel blocker (CCB; 32%). For tritherapy, it was prescribed with CCB and D in 28% and β-blocker and D in 26%. In 8.9% of patients, aliskiren was prescribed with an ACEi or an ARB.
  
  
  CONCLUSIONS
  French physicians are generally following the current prescribing recommendations for aliskiren, but the place of this new class of antihypertensive in the management of essential hypertension will become clearer with longer experience, especially concerning effective doses and combinations.
authors.affiliation: CHU de Poitiers, Cardiology Department, Poitiers, France. philippe.sosner@univ-poitiers.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Sosner
authors.forename: Béatrice
authors.initials: B
authors.lastname: Fiquet
authors.forename: Stéphane
authors.initials: S
authors.lastname: Quere
authors.forename: Alain
authors.initials: A
authors.lastname: Francillon
authors.forename: Daniel
authors.initials: D
authors.lastname: Herpin
mesh_terms: D000368:Aged; D000577:Amides / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D005650:Fumarates / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D000092502:Renin Inhibitors
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D005650:Fumarates; D000092502:Renin Inhibitors; C446481:aliskiren