Analysis of the use of angiotensin converting enzyme inhibitors In the Republic of Serbia in the period from 2012 to 2021

Introduction: An estimated 1.28 billion people worldwide, aged 30 to 79 years have hypertension, a major risk factor for numerous cardiovascular complications. Adequate therapy can significantly reduce these risks. Today angiotensin converting enzyme (ACE) inhibitors are the drugs of choice in the treatment of hypertension, and are also used in the treatment of heart failure, myocardial infarction and kidney failure, which ranks them among the most commonly prescribed drugs in practice. Aim: The aim of this study was to analyze the consumption of ACE inhibitors in the Republic of Serbia in the period from 2012 to 2021 as well as to examine the relationship between their prices and consumption. Material and Method: Data on medication consumption and pricing were obtained from the official website of the Agency for Medicines and Medical Devices of the Republic of Serbia (ALIMS). Drug utilization analysis was conducted using an internationally established methodology based on the concept of anatomical-therapeutic-chemical classification of drugs (ATC) and defined daily dose (DDD) along with the DU90% method. Results: In the Republic of Serbia higher consumption of monocomponent ACE inhibitors was recorded compared to their fixed-dose combinations. The most frequently used were enalapril and ramipril, which can be related to their lower prices. Conclusion: Given the substantial body of evidence indicating the advantages of perindopril compared to other ACE inhibitors, more frequent use of this drug should be considered. When prescribing ACE inhibitors advantage should also more often be given to fixed-dose combinations because about 75% of hypertensive patients require dual therapy to achieve blood pressure control. The use of fixed-dose combinations has been shown to significantly improve both compliance and adherence.