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Patient preference for therapies in hypertension: a cross-sectional survey of German patients

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Abstract

Background

Hypertension is poorly controlled in numerous patients despite effective medication being available. Catheter-based renal denervation (RDN) has emerged as an alternative treatment option. We aimed to assess how likely patients with elevated blood pressure (BP) are to accept RDN as treatment option.

Methods

A questionnaire-based cross-sectional survey was performed in patients with elevated BP in Germany. Data on patient demographics, clinical characteristics and treatment preferences were collected, anonymized and analyzed.

Results

One thousand and eleven patients completed the survey. Mean age was 66 years (55% male). If not already on medication (n = 172), 38.2% of patients would prefer RDN. Of those already on drug therapy (n = 839), 28.2% would opt for RDN. Patients who were pro-RDN were younger (p < 0.0001) and more often male (p < 0.0001). Nineteen percent would choose RDN if it lowered systolic BP by at least 20 mmHg, more than 40% if they did not have to take any more pills thereafter, and 30% if it would lower BP by at least 10 mmHg. Experiences of side effects and drug adherence were identified as determinants of patient preference. Physicians were the main source of information regarding medical problems (95.5%) and influence patients’ decision regarding therapies (98%).

Conclusions

This survey found that a significant proportion of patients would choose catheter-based RDN over lifelong pharmacotherapy. These patients were younger and more likely to be male but their expectation of the extent of BP decrease with RDN was high. Physicians are key mediators for treatment selection. They need to incorporate patient preferences into shared decision making.

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Acknowledgements

This survey was supported by an unrestricted grant by Medtronic, Inc., Minneapolis, USA (Grant no. A1355749.001.1). We gratefully acknowledge the expert assistance of Ingrid Fleischmann and Kristina Striepe.

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Authors and Affiliations

  1. Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University, Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany

    Roland E. Schmieder, Susanne Jung & Christian Ott

  2. Institute of Preventive Medicine, Hospital Nuremberg and University Hospital Erlangen, Friedrich-Alexander-University, Erlangen-Nuremberg, Erlangen, Germany

    Roland E. Schmieder, Karin Högerl & Roland Veelken

  3. Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany

    Peter Bramlage

  4. Paracelsus Medical School, Nuremberg, Germany

    Roland Veelken & Christian Ott

Authors
  1. Roland E. Schmieder
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  2. Karin Högerl
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  5. Roland Veelken
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Corresponding author

Correspondence to Roland E. Schmieder.

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Conflict of interest

RES received Speaker fees, Consultancy and Advisory Board fees from Ablative Solutions, Medtronic, Recor and ROX Medical. Research grant to the institution has been given to RES by Ablative Solutions, Medtronic, Recor and ROX Medical. RV received a research grant to the institution from Medtronic. All the other authors have no competing financial interests to declare.

Ethical approval

Ethical approval was obtained (University of Erlangen-Nuremberg, Germany).

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Schmieder, R.E., Högerl, K., Jung, S. et al. Patient preference for therapies in hypertension: a cross-sectional survey of German patients. Clin Res Cardiol 108, 1331–1342 (2019). https://doi.org/10.1007/s00392-019-01468-0

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  • DOI: https://doi.org/10.1007/s00392-019-01468-0

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