Determinants of persistence in hypertensive patients treated with irbesartan: Results of a postmarketing survey

被引:21
作者
Burnier M. [1 ]
Hess B. [2 ]
Greminger P. [3 ]
Waeber B. [4 ]
机构
[1] Service de Néphrologie, CHUV, Lausanne
[2] Spital Zimmerberg, Wädenswil
[3] Medizinische Poliklinik, Universitätsspital, Zürich
[4] Division de Physiopathologie Clinique, CHUV, Lausanne
关键词
Hypertensive Patient; Irbesartan; Systolic Hypertension; Drug Adherence; Good Tolerability Profile;
D O I
10.1186/1471-2261-5-13
中图分类号
学科分类号
摘要
Background: Persistence is a key factor for long-term blood pressure control, which is of high prognostic importance for patients at increased cardiovascular risk. Here we present the results of a post-marketing survey including 4769 hypertensive patients treated with irbesartan in 886 general practices in Switzerland. The goal of this survey was to evaluate the tolerance and the blood pressure lowering effect of irbesartan as well as the factors affecting persistence in a large unselected population. Methods: Prospective observational survey conducted in general practices in all regions of Switzerland. Previously untreated and uncontrolled pre-treated patients were started with a daily dose of 150 mg irbesartan and followed up to 6 months. Results: After an observation time slightly exceeding 4 months, the average reduction in systolic and diastolic blood pressure was 20 (95% confidence interval (CI) -19.6 to -20.7 mmHg) and 12 mmHg (95% CI -11.4 to -12.1 mmHg), respectively. At this time, 26% of patients had a blood pressure < 140/90 mmHg and 60% had a diastolic blood pressure < 90 mmHg. The drug was well tolerated with an incidence of adverse events (dizziness, headaches,...) of 8.0%. In this survey more than 80% of patients were still on irbesartan at 4 month. The most important factors predictive of persistence were the tolerability profile and the ability to achieve a blood pressure target ≤ 140/90 mmHg before visit 2. Patients who switched from a fixed combination treatment tended to discontinue irbesartan more often whereas those who abandoned the previous treatment because of cough (a class side effect of ACE-Inhibitors) were more persistent with irbesartan. Conclusion: The results of this survey confirm that irbesartan is effective, well tolerated and well accepted by patients, as indicated by the good persistence. This post-marketing survey also emphasizes the importance of the tolerability profile and of achieving an early control of blood pressure as positive predictors of persistence. © 2005 Burnier et al; licensee BioMed Central Ltd.
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页数:11
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共 35 条
[1]  
Cohn J.N., Tognoni G., A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure, N. Engl. J. Med., 345, pp. 1667-1675, (2001)
[2]  
Pfeffer M.A., Swedberg K., Granger C.B., Held P., McMurray J.J., Michelson E.L., Olofsson B., Ostergren J., Yusuf S., Pocock S., Effects of candesartan on mortality and morbidity in patients with chronic heart failure: The CHARM-Overall programme, Lancet, 362, pp. 759-766, (2003)
[3]  
Lindholm L.H., Ibsen H., Dahlof B., Devereux R.B., Beevers G., de Faire U., Fyhrquist F., Julius S., Kjeldsen S.E., Kristiansson K., Lederballe-Pedersen O., Nieminen M.S., Omvik P., Oparil S., Wedel H., Aurup P., Edelman J., Snapinn S., Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): A randomised trial against atenolol, Lancet, 359, pp. 1004-1010, (2002)
[4]  
Parving H.H., Lehnert H., Brochner-Mortensen J., Gomis R., Andersen S., Arner P., The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes, N. Engl. J. Med., 345, pp. 870-878, (2001)
[5]  
Lewis E.J., Hunsicker L.G., Clarke W.R., Berl T., Pohl M.A., Lewis J.B., Ritz E., Atkins R.C., Rohde R., Raz I., Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes, N. Engl. J. Med., 345, pp. 851-860, (2001)
[6]  
Brenner B.M., Cooper M.E., de Zeeuw D., Keane W.F., Mitch W.E., Parving H.H., Remuzzi G., Snapinn S.M., Zhang Z., Shahinfar S., Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy, N. Engl. J. Med., 345, pp. 861-869, (2001)
[7]  
Pfeffer M.A., McMurray J.J., Velazquez E.J., Rouleau J.L., Kober L., Maggioni A.P., Solomon S.D., Swedberg K., Van de Werf F., White H., Leimberger J.D., Henis M., Edwards S., Zelenkofske S., Sellers M.A., Califf R.M., Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both, N. Engl. J. Med., 349, pp. 1893-1906, (2003)
[8]  
Chobanian A.V., Bakris G.L., Black H.R., Cushman W.C., Green L.A., Izzo Jr. J.L., Jones D.W., Materson B.J., Oparil S., Wright Jr. J.T., Roccella E.J., The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report, JAMA, 289, pp. 2560-2572, (2003)
[9]  
European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension, J. Hypertens., 21, pp. 1011-1053, (2003)
[10]  
Burt V.L., Cutler J.A., Higgins M., Horan M.J., Labarthe D., Whelton P., Brown C., Roccella E.J., Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991, Hypertension, 26, pp. 60-69, (1995)