Angiotensin-I I Receptor Blockers
The UK has the highest incidence of cardiovascular
predominantly conservative – treatment decisions,
Controlling hypertension through lowering blood
NICE guidelines on treatments for hypertension
pressure has been demonstrated to reduce the
will not be available before Summer 2003.
It is likely that doctors will wait for these
Angiotensin-II Receptor Blockers (ARBs) have
guidelines before changing their prescribing habits.
fewer side effects than older medicines; fewer
In the meantime, more UK patients are receiving
side effects improve compliance with treatment
If uptake in the UK was similar to other countries
Uptake of ARBs is significantly lower in the UK
in Europe, there could be almost 1000 fewer
deaths from cardiovascular causes per year and asmany as 2,500 fewer strokes (Dahlof et al., Lancet
A regression analysis to identify the reasons for
lower uptake in the UK shows that "preference"factors, i.e. doctors making different –
The UK has the highest incidence of cardiovascular disease and
hypertension in Europe, and death from heart disease in the UK issignificantly higher than the European average. Hypertension is directly
linked to increases in mortality from heart disease and stroke: the higher
the blood pressure, the higher the risk. Controlling hypertension through
treatments to be effective, medicationhas to be consistently taken - compliance
lowering blood pressure reduces the risk of heart disease and stroke.
Low Uptake in the UK
and diuretics, have unpleasant side-effects which generally reduce
The use of ARBs is consistently lower in the UK than in other major
European countries. For the UK to be on a par with its major European
neighbours, 700,000 more patients would have to be treated with ARBs.
co-morbid conditions (e.g. no beta-blockers with asthma or
or "sartans"), appear to be as effective
as the older ones in reducing bloodpressure, but have significantly fewer
interactions with other medicines andcan be used in patients who have other
disease than older anti-hypertensives.
Such as bradycardia, somnolence, masking of hypoglycaemic symptoms, erectile dysfunction in beta-blockers, or mineral imbalance,hyperuricaemia, thrombosis with diuretics.
Cowley AJ, Wiens BL, Segal R, Rich MW, Santanello NC, Dasbach EJ, Pitt B, on behalf of the ELITE Investigators. Evaluation of Losartan in theElderly. Randomised comparison of losartan vs. captopril on quality of life in elderly patients with symptomatic heart failure: the losartan heartfailure ELITE quality of life substudy. Qual Life Res 2000;9(4):377-84
The Reasons for Low Uptake
There are a number of factors that could explain the lower uptake of ARBs in
the UK compared with other European countries: their cost relative to otheranti-hypertensive products, differences in pharmaceutical company promotion,
Evidence exists of theadvantages of ARBs over older
or later availability in the UK. The existence of guidelines could also influence
prescribing behaviour. It could also be that doctors simply prefer to prescribeolder, "tried and tested" products, perhaps because of pressure to control costs,
Published evidence shows thatif uptake in the UK were
or because of a general reluctance to prescribe new products in the face of
The reasons for low uptake in the UK were investigated in a regression analysis3.
Whilst relative cost and relative promotion contributed to some extent, it was
predominantly the constant term – which would account for "soft" variables
such as doctors’ preferences (for older products) – that explained the
differences between the UK and other countries.
Contribution (%) of different factors in explaining
the differences in uptake of ARBs in the UK versus other
major European countries
Although there were guidelines introduced in the UK in 1999 (stating that firstline treatment for hypertension should consist of beta-blockers and diuretics),these could be shown to have little impact on prescribing behaviour, as anoverall upward trend in the use of ARBs continued.
Copies of the full regression
study are available from:
EMG, PO Box 306, Teddington,
Middlesex, TW11 9WB.
Regression analysis performed by MAPI Values, The Adelphi Mill, Bollington, Cheshire, UK.
Dahlof B, Devereux RB, Kjeldsen SE et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction inhypertension study (LIFE): a randomised trial against atenolol. Lancet 2002 Mar 23;359 (9311):995-1003
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