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Background: Major antihypertensive drug classes (but not Imidazoline Receptor Agonists) have been demonstrated to reduce cardiovascular morbidity and mortality. In 2017, Latvia and Lithuania had the highest cardiovascular mortality among the Eastern, Central, Northern, and Western Member States of the European Union (EU). Cardiovascular mortality in Estonia is much lower than in Lithuania and Latvia. Objective: To evaluate the consumption of Imidazoline Receptor Agonists in the Baltic States and its potential implications. Materials and Methods: The study included data on the sales of Imidazoline Receptor Agonists in Lithuania, Latvia, and Estonia; the marketing authorization databases of the competent authorities; the guidelines on the treatment of hypertension, and the reimbursement conditions. Results: The study showed a very high consumption of the Imidazoline Receptor Agonists in Lithuania and Latvia. From 2016 to 2019, the average consumption of Imidazoline Receptor Agonists in Lithuania was 15.5 times higher than in Estonia; in Latvia, it was 8.9 times higher than in Estonia. The guidelines recommend the use of the Imidazoline Receptors Agonists as one of the last options in hypertension therapy, but the marketing authorizations do not restrict their line of therapy. Conclusions: Consumption of IRAs in Lithuania and Latvia is very high. The authorized use of the IRAs in the EU Member States is not in line with the guidelines on the management of arterial hypertension and therefore patients might be deprived of therapies that reduce the cardiovascular risk. The drug regulatory authorities of the EU should review the data on the safety and efficacy of the IRAs and restrict their therapeutic indications if necessary. [ABSTRACT FROM AUTHOR]

Illegal drug use was already a problem in the Baltic countries in the Soviet era, when the Iron Curtain was still in place. At independence the Baltic countries inherited drug treatment system, operated mainly by psychiatrists and based on inpatient system. As the Soviet treatment model was abandoned and professionals in the Baltic countries turned to the West, the drug treatment field became open to the Western drug treatment experience, especially from European countries and USA. Unexpectedly, they were to be exposed to different and often conflicting concepts of treatment modalities, which usually competed with one another in claims of being the most effective and useful. The question remains open as to which programs will be developed to meet the growing demand for treatment in each country and how widely they will be adopted. [ABSTRACT FROM AUTHOR]