Features of antihypertensive therapy and real-world prescription of selective imidazoline receptor agonists in Russia vs other countries: STRAIGHT study data analysis

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Abstract

Analysis of routine clinical practice of hypertensive patient management represents one of the important tools in the search for further ways to minimize hypertension-associated cardiovascular and renal adverse outcomes.

Aim. To compare the strategies for hypertension management and features of clinical use of I1-imidazoline receptor (I1-IR) agonists in the Russian Federation and other countries where the STRAIGHT (Selective imidazoline receptor agonists Treatment Recommendation and Action In Global management of HyperTension) study was conducted.

Materials and methods. It was a cross-sectional online study involving physicians of various specializations. The study was conducted from January 18 to July 1, 2019, in seven countries with a high rate of I1-IR agonist prescription, including Russia.

Results. A total of 125 (4.5%) responders filled out the survey in the Russian Federation, which was somewhat lower than in other countries (6.8%). The participants were mostly general practitioners (54.0%) and cardiologists (42.0%), while in other countries greater diversity was seen. Most Russian physicians (83.0%) seemed to rely on national clinical guidelines in their routine practice, while in other countries the US guidelines were more popular (66.0%). The majority of responders stated that they took into account the traditional risk factors of hypertension when initiating the therapy; every second responder noted if sleep apnea was present. Awareness of I1-IR agonists, their prescription rate and their preference were higher in Russia. The main reported benefits of I1-IR agonists were their efficacy, including in resistant hypertension, and their metabolic effects (in Russia). Most participants preferred I1-IR agonists as third-line therapy (65.0% in Russia vs 60.0% in other countries) and in combination with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blockers (ARB) (55.0% in Russia vs 54.0% in other countries). Compared to responders from other countries, Russian physicians prescribe I1-IR agonists as first-line (15.0% vs 5.0%) and second-line (48.0% vs 21.0%) therapy more often.

Conclusion. Russian physicians were the most aware of I1-IR agonists and tended to prescribe drugs of this class for hypertension management more often, and I1-IR agonist combination with ACEi was preferable compared to physician responders from other countries. Antihypertensive efficacy and metabolic effects were reported as the major benefits of I1-IR agonist therapy.

About the authors

Alexandra O. Konradi

Almazov National Medical Research Centre

Email: zvartau@almazovcentre.ru
ORCID iD: 0000-0001-8169-7812

чл.-кор. РАН, д.м.н., проф., зам. ген. дир. по науч. работе, рук. научно-исследовательского отд. артериальной гипертензии Института сердца и сосудов

Russian Federation, Saint Petersburg

Nadezhda E. Zvartau

Almazov National Medical Research Centre

Author for correspondence.
Email: zvartau@almazovcentre.ru
ORCID iD: 0000-0001-6533-5950

к.м.н., зам. ген. дир. по работе с регионами, нач. управления по реализации федеральных проектов, доц. каф. внутренних болезней

Russian Federation, Saint Petersburg

Irina E. Chazova

National Medical Research Center of Cardiology

Email: zvartau@almazovcentre.ru
ORCID iD: 0000-0002-9822-4357

акад. РАН, д.м.н., проф., зам. ген. дир. ФГБУ «НМИЦ кардиологии» по научно-экспертной работе, рук. отд. гипертонии Института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Juliya V. Zhernakova

National Medical Research Center of Cardiology

Email: zvartau@almazovcentre.ru
ORCID iD: 0000-0001-7895-9068

д.м.н., проф., ст. науч. сотр. отд. координации и мониторинга научных программ

Russian Federation, Moscow

Aletta E. Schutte

School of Population Health, University of New South Wales; The George Institute for Globally Health; Hypertension in Africa Research Team; MRC Unit for Hypertension and Cardiovascular Disease, North-West University

Email: zvartau@almazovcentre.ru
ORCID iD: 0000-0001-9217-4937

проф., гл. рук. по кардиологиии, сердечно-сосудистой и метаболической медицины Школы здоровья населения Университета Нового Южного Уэльса; Институт глобального здоровья Джорджа; Ассоциация исследователей гипертонии Африки; Подразделение Совета медицинских исследований по гипертонии и сердечно-сосудистым заболеваниям Северо-Западного университета

Australia, Sydney; Potchefstroom

Markus P. Schlaich

Dobney Hypertension Centre, School of Medicine – Royal Perth Hospital Unit/Medical Research Foundation, University of Western Australia

Email: zvartau@almazovcentre.ru
ORCID iD: 0000-0002-1765-0195

проф. Центра гипертонии Добни, Школа медицины Королевского госпиталя города Перта/Учреждение медицинских исследований, Университет Западной Австралии; нефролог, спец. по артериальной гипертонии; дир. регионального Южно-Тихоокеанского офиса Всемирной лиги борьбы с гипертонией (WHL), председатель отд. корпоративных связей Международного общества артериальной гипертензии (ISH), президент Cовета по изучению высокого артериального давления Австралии (HBPRCA), ст. науч. сотр. Национального совета по здоровью и медицинским исследованиям (NHMRC), член Американского общества кардиологов (FAHA), член Европейского общества кардиологов (FESC)

Australia, Perth

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2. Fig. 1. Experience of specialists participating in the research

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3. Fig. 2. Factors considered when initiating antihypertensive therapy

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4. Fig. 3. Factors taken into account in the appointment, and the place of selective AIR in the treatment of hypertension

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5. Fig. 4. Possible target groups for the appointment of selective AIR in the treatment of hypertension

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6. Fig. 5. Features of the appointment of antihypertensive therapy in specific clinical situations

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