AchievemenT of target resting HEart rate on beta-blockers in patients with stable angiNA and hypertension (ATHENA) in routine clinical practice in Russia

Abstract

Objectives:

The primary objective of this study was to establish the proportion of patients with stable angina and arterial hypertension on beta-blocker (BB) treatment reaching target resting heart rates (RHR) of 55–60 beats per min in clinical cardiology and general practice in Russia. Secondary objectives included the association between achievement of target RHR and mean BB doses, Seattle Angina Questionnaire (SAQ) scores and achievement of target blood pressure (BP) levels (systolic/diastolic BP <140/90 mmHg).

Research design and methods:

ATHENA (AchievemenT of target resting HEart rate on beta-blockers in patients with stable angiNA and hypertension) was a non-interventional, cross-sectional, observational study conducted in 20 sites in Russia (NCT01321242). The study population comprised patients aged ≥18 years with stable angina (class I–III) and primary hypertension, on BB treatment for ≥2 months prior to enrollment.

Results:

Of 399 study participants, 62 (15.5%; 95% confidence interval [CI]: 0.121 to 0.195) achieved target RHR. Clinical characteristics associated with significant differences between subgroups achieving and not achieving target RHR were systolic BP (131.1 vs 138.2 mmHg, P = 0.006), diastolic BP (78.6 vs 83.5 mmHg, P < 0.001) and frequency of nitroglycerin administration (1.5% vs 3.0%, P = 0.045). Most patients were taking bisoprolol (48.9%) and metoprolol (36.1%), with mean daily doses of 5.5 mg and 73.7 mg, respectively. Median SAQ scores were: 52.8 physical limitation, 50.0 angina stability, 60.0 angina frequency, 75.0 treatment satisfaction, 50.0 disease perception (quality of life) and 59.6 total score, with no significant differences between subgroups. Patients achieving target RHR were significantly more likely also to achieve target BP, compared with patients not achieving target RHR (72.6% vs 53.4%; P = 0.005; odds ratio: 2.309; 95% CI: 1.270 to 4.197).

Conclusion:

In a Russian population with stable angina and hypertension on BB treatment, RHR control was suboptimal.

ClinicalTrials.gov identifier:

ClinicalTrials.gov identifier: NCT01321242.

Keywords::

• Adrenergic beta-antagonists
• Angina, stable
• Antihypertensive agents
• Cardiovascular diseases/drug therapy
• Epidemiologic studies
• Heart rate
• Hypertension

Transparency

Declaration of funding

This study was funded by AstraZeneca. The authors had full access to all data and had final responsibility for the contents of the manuscript and the decision to submit it for publication.

Declaration of financial/other relationships

Z.K. has disclosed that she has received grants from AstraZeneca. Y.K. has disclosed that she is an employee of AstraZeneca. G.K. has disclosed that he has no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

The authors would like to thank the ATHENA investigators; Ekaterinburg: I.I. Katsuba, G.I. Sokolovskaya; Krasnodar: N.V. Klimenko, O.I. Chaschina; Moscow: T.K. Chernyavskaya, O.I. Nesterenko, A.G. Evdokimova, A.Y.A. Ivleva; Rostov-on-Don: A.V. Khripun; Saint Petersburg: I.A. Zobenko, O.O. Kvasova, T.N. Novikova; Saratov: E.V. Podzemelnikov, S.S. Parshina, T.N. Afanaseva; Ulyanovsk: S.N. Tolstov, P.A. Barov, S.G. Feofanov, E.I. Usacheva.

Medical writing services were provided by Ioana Dumitrescu PhD of Informed Direct, Macclesfield, UK and were funded by AstraZeneca.

Previous presentations: Two abstracts presented at the 23rd European Meeting on Hypertension and Cardiovascular Protection in Milan, Italy (14–17 June 2013): Akhmetov R, Kiyakbaev G, Kobalava ZH. Relationship between achievement of goal resting heart rate and target blood pressure level on beta-blockers in patients with stable angina and hypertension in real clinical practice. Akhmetov R, Kiyakbaev G, Khomitskaya Y, Kobalava ZH. Achievement of goal resting heart rate on beta-blockers in patients with stable angina and hypertension in routine practice (ATHENA).