Use of angiotensin-converting enzyme inhibitors and diuretics in antihypertensive therapy advised by Polish medical doctors – a final report from questionnaire ALMONDS study Original article

Abstract

Introduction: Data from clinical trials have demonstrated an improvement in long-term outcomes in subjects at high risk of cardiovascular events treated with ramipril and perindopril, as well as in patients with a history of acute myocardial infarction treated with zofenopril. These observations have revolutionized the position of angiotensin-converting enzyme (ACE) in antihypertensive therapy. Diuretics were commonly seen as medicaments that adversely influenced the metabolism of carbohydrates and lipids. Metabolic neutral and well-tolerated newer drugs within the class have changed this view. However, the observed benefits refer only to particular molecules within the class, thus indicating their superiority over other molecules.

The aim of the study: The aim of the questionnaire ALMONDS study was to identify the attitude of Polish medical professionals towards novel pharmacological agents used in the therapy of arterial hypertension. Especially, we sought to investigate the views regarding the class effect within antihypertensive agents.

Materials and methods: The study was conducted using the standardized survey, which was filled in by 784 medical doctors, who specialize in cardiology, internal medicine, primary health care and diabetology. All participants received the survey by post and remained anonymous, which allowed to maximize the reliability of collected data.

Results: Among ACE inhibitors, zofenopril and ramipril were recognized as particularly beneficial in terms of cardiovascular mortality and morbidity (83.5% of women, 79.1% of men). The most frequently cited clinical trial that demonstrated lack of class effect within ACE inhibitors was SMILE-4 study, which compared zofenopril with ramipril (74.2% of women, 70.5% of men). The majority of study participants declared, that a combination of ACE inhibitors and angiotensin II receptor antagonists is harmful (50.9% of women, 48.8% of men). Among diuretics used in antihypertensive therapy, the majority of study participants chose thiazide-like diuretics (38.7% of women, 41.2% of men). In treatment of refractory hypertension, torasemid and indapamid were most frequently selected (58.2% of women, 55.7% of men and 19.3% of women, 18.1% of men, respectively). Among novel diuretics, the greatest future perspectives were declared for torasemid in different doses (67.2% of women, 61.5% of men). The majority of study participants admitted that torasemid is superior to furosemide within the class of loop diuretics (89.5% of women, 89.2% of men).

Conclusions: The results of the study indicate that Polish medical specialists have clear preferences regarding the choice of specific pharmacological agents within the groups in treatment of hypertension. Among ACE inhibitors, zofenopril and ramipril were preferred, whereas among diuretics, torasemid and indapamid were the most frequently selected. This attitude remains coherent with the Guidelines of Polish Society of Arterial Hypertension, 2015.