In Europe, stroke is the third leading cause of death, behind heart disease and cancer with 650,000 stroke deaths each year. A leading risk factor for stroke is uncontrolled hypertension, which could explain why stroke remains a major burden in Europe – the incidence of hypertension is 60 percent higher than the US. Among persons aged 35 to 64 years, 66 percent of US hypertensives had their blood pressure controlled at 160/95mm Hg compared to only 23 to 38 percent in Europe.
Speaking at the meeting, which coincides with the European Society of Cardiology Congress, Mary Baker, president of the European Federation of Neurological Associations, said: "Stroke is the most preventable and prevalent neurological disease and has tremendous impact on patients, their families and healthcare systems in general. These worrying statistics are a sign that Europe as a whole needs to do more to reduce the incidence and devastating impact of stroke."
Results from the Global Reality of Attitudes on Stroke Prevention and Hypertension (GRASP) survey show that 48 percent of physicians give stroke "extremely high consideration" when selecting a treatment for hypertension and 67 percent of physicians say certain hypertension therapies are more effective than others at lowering the risk of a first stroke. However, despite the high level of physician awareness about the link between hypertension and stroke, many patients are not seeing a benefit.
But, steps are being taken to address this problem. The landmark Losartan Intervention for Endpoint reduction in hypertension study (LIFE) was used as the basis for recent updates made to the European Society of Hypertension/European Society of Cardiology hypertension guidelines regarding prescribing of angiotensin II antagonists (AIIAs).
New data increases the understanding of the most effective prescribing strategies for controlling hypertension and reducing the burden of stroke. Importantly, data can also give an insight into the potential ‘real life’ of adjusting prescribing practices according to the latest clinical evidence.
Professor Bjorn Dahlof, Associate Professor of Medicine, Ostra Goteborg University, Sweden, presented data, based on the LIFE study and recently published in the Journal of Human Hypertension, suggesting that a population-wide strategy of using Losartan from Merck Sharp & Dohme could prevent over 125,000 first strokes during a 5.5 year period in Europe.
Professor Dahlof stated: "I urge physicians and policy makers to act on clinical findings on stroke risk reduction to ensure best practice in the management of hypertension. Minimizing the risk of stroke should be a major objective when treating patients with hypertension and current clinical evidence should be considered by physicians when making prescribing decisions in their practice."
The LIFE study, originally published in The Lancet in 2002, showed that Losartan from Merck Sharp & Dohme significantly reduced the combined risk of cardiovascular death, heart attack and stroke in patients with hypertension and LVH by 13 percent and the risk of stroke alone by 25 percent compared to a regimen based on the beta blocker atenolol.
Even though reductions in blood pressure were similar for both groups, the LIFE data clearly showed the benefits of Losartan over atenolol for stroke reduction, beyond blood pressure control alone. This was the first time a difference between two antihypertensive agents in terms of long-term outcome had been demonstrated in hypertensive patients with LVH.
To date, more than 25 countries, including the Philippines, have granted new indications for MSD’s Losartan based on the LIFE study. Results from LIFE sub-studies continue to be published, providing further support for the benefits of the MSD medicine in terms of reducing the risk of stroke for the individual patient in terms of public health, with the new data on the cost-effectiveness of a losartanbased regimen being presented at the ESC.
In the Philippines, only Losartan from Merck Sharp and Dohme has BFAD’s approval for the reduction in the risk of cardiovascular morbidity and mortality in hypertensive patients with left ventricular hypertrophy and for renal protection in type 2 diabetic patients with proteinuria. Being one of the popularly prescribed medicines, it should be taken only with a doctor’s prescription.
