Müller Axel, Schweizer Johannes, Kirch Wilhelm, Schindler Christoph
Klinik für Innere Medizin I der Klinikum Chemnitz gGmbH, Chemnitz.
Med Klin (Munich). 2010 Mar;105(3):155-62. doi: 10.1007/s00063-010-1025-7. Epub 2010 Mar 28.
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.
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.
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.
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.
开展本药物利用研究项目是为了评估阿利吉仑（一种具有全新药理作用模式的药物）上市时抗高血压药物治疗的现状，并研究这一新治疗原则的潜在治疗价值。
在德国的1431家初级保健机构中，要求全科医生和内科专科医生确定不同抗高血压药物的治疗价值（2007年第三和第四季度）。还要求医生阐述直接肾素抑制这一新治疗原则的潜在优势。通过使用第二份调查问卷，收集了每个因当前抗高血压治疗反应不佳而被视为在各自医疗实践中接受阿利吉仑的最佳候选抗高血压患者的年龄、性别和合并症等额外流行病学数据。
在1（非常重要）至6（不重要）的评分范围内，抗高血压药物的治疗价值评判如下：血管紧张素抑制酶（ACE）抑制剂（98.8%）、血管紧张素（AT）（1）受体阻滞剂（87.4%）、β受体阻滞剂（71.2%）、钙通道阻滞剂（58.9%）、噻嗪类利尿剂（56.3%）和襻利尿剂（32.3%）被评为1（非常重要）和2（重要）。在本次调查纳入的总共14358名患者中，收集了年龄、性别、动脉高血压的严重程度和病程、并发症和合并症以及详细的用药史。50.3%的患者接受了ACE抑制剂，27.9%接受了AT（1）受体阻滞剂，45.7%接受了β受体阻滞剂，37.5%接受了钙通道阻滞剂，53.2%接受了利尿剂。截至数据收集时，主要合并症为糖尿病（43.8%）、冠心病（37.3%）和慢性心力衰竭（20.7%）。89.4%的糖尿病患者接受了ACE抑制剂或AT（1）受体阻滞剂，而未患糖尿病的患者这一比例为69.6%。
根据参与本研究的初级保健医生的评估，阿利吉仑可能对重度动脉高血压患者、病程已较长的患者以及存在糖尿病等合并症的患者的抗高血压治疗有用。本研究队列中已接受ACE抑制剂或AT（1）受体阻滞剂治疗的患者比例较高，表明初级保健医生对当前治疗指南的依从性良好。本研究中32.3%的主治医生将襻利尿剂评估为重要的抗高血压药物，这需要进行批判性讨论。
