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The Minimal Impact of a Big Hypertension Study
NY Times ^ | November 28, 2008 | ANDREW POLLACK

Posted on 11/29/2008 11:02:07 PM PST by neverdem

The Evidence Gap

The surprising news made headlines in December 2002. Generic pills for high blood pressure, which had been in use since the 1950s and cost only pennies a day, worked better than newer drugs that were up to 20 times as expensive.

The findings, from one of the biggest clinical trials ever organized by the federal government, promised to save the nation billions of dollars in treating the tens of millions of Americans with hypertension — even if the conclusions did seem to threaten pharmaceutical giants like Pfizer that were making big money on blockbuster hypertension drugs.

Six years later, though, the use of the inexpensive pills, called diuretics, is far smaller than some of the trial’s organizers had hoped.

“It should have more than doubled,” said Dr. Curt D. Furberg, a public health sciences professor at Wake Forest University who was the first chairman of the steering committee for the study, which was known by the acronym Allhat. “The impact was disappointing.”

The percentage of hypertension patients receiving a diuretic rose to around 40 percent in the year after the Allhat results were announced, up from 30 to 35 percent beforehand, according to some studies. But use of diuretics has since stayed at that plateau. And over all, use of newer hypertension drugs has grown faster than the use of diuretics since 2002, according to Medco Health Solutions, a pharmacy benefits manager.

The Allhat experience is worth remembering now, as some policy experts and government officials call for more such studies to directly compare drugs or other treatments, as a way to stem runaway medical costs and improve care.

The aftereffects of the study show how hard it is to change medical practice, even after a...

--snip--

There were also more new cases of diabetes among the...

(Excerpt) Read more at nytimes.com ...


TOPICS: Culture/Society; Extended News; Government; Testing
KEYWORDS: allhat; bloodpressure; diuretics; health; hypertension; medicine
Major Outcomes in Moderately Hypercholesterolemic, Hypertensive Patients Randomized to Pravastatin vs Usual Care

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT)

1 posted on 11/29/2008 11:02:07 PM PST by neverdem
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To: austinmark; FreedomCalls; IslandJeff; JRochelle; MarMema; Txsleuth; Newtoidaho; texas booster; ...
Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic

It helps reading the abstract first.

FReepmail me if you want on or off the diabetes ping list.

2 posted on 11/29/2008 11:14:20 PM PST by neverdem (Xin loi min oi)
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To: neverdem

Thanks, I read the NY article in some detail. Interesting to see the relative prescribing rates of the various classes of anti-hypertensives; I did not realize beta blockers were so far down on the list. Also don’t understand why they keep prescribing BBs for my wife when they can worsen diabetes symptoms.


3 posted on 11/29/2008 11:31:12 PM PST by steve86 (Acerbic by nature, not nurture™)
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To: neverdem
Neverdem, are you a doctor?

And if so what is your take on Pravastatin?

4 posted on 11/30/2008 12:03:02 AM PST by DB
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To: neverdem
Got any references to studies similar in size and design with two treatment groups as follows:

1. Either of the drugs used in this study.
2. Diet and lifestyle changes as recommended by, say, Heart and Stroke Foundation.

Thanks
5 posted on 11/30/2008 12:50:56 AM PST by caveat emptor
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To: steve86
Thanks, I read the NY article in some detail. Interesting to see the relative prescribing rates of the various classes of anti-hypertensives; I did not realize beta blockers were so far down on the list.

I think you got the wrong message. Beta blockers are so high on the list for CHD that ALLHAT didn't question them, just the relaive benefits of chlorthalidone the diuretic, amlodipine the calcium channel blocker and lisinopril the ACE inhibitor for hypertension.

6 posted on 11/30/2008 1:19:47 AM PST by neverdem (Xin loi min oi)
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To: DB
Neverdem, are you a doctor?

Yes, I'm guilty.

And if so what is your take on Pravastatin?

I'm not impressed from ALLHAT's abstract.

7 posted on 11/30/2008 1:28:59 AM PST by neverdem (Xin loi min oi)
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To: neverdem

My doctor recently put me on it and I’m not sure what to think about it. Whether the risk is higher with it or without it...


8 posted on 11/30/2008 1:38:14 AM PST by DB
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To: caveat emptor
There's nothing that's convenient.

All drug classes are problematic.

9 posted on 11/30/2008 1:44:44 AM PST by neverdem (Xin loi min oi)
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To: neverdem

The article said — “Six years later, though, the use of the inexpensive pills, called diuretics, is far smaller than some of the trial’s organizers had hope.”

It seems that the diuretics are the first place to start treatment for high blood pressure. I was wondering about that as it seems that my blood pressure may be very slightly climbing.

I guess a trip to the doctor to examine the question about how to treat a very minimal rise in blood pressure would be in order. I just wanted to know some things ahead of time and not get prescribed some expensive medicine when something very simple and minimal would do just fine. This study seems to help answer part of that question...


10 posted on 11/30/2008 1:53:43 AM PST by Star Traveler
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To: DB
My doctor recently put me on it and I’m not sure what to think about it. Whether the risk is higher with it or without it...

Get your liver enzymes checked, ALT and AST, periodically. Report any muscle weakness, pain or tenderness as soon as possible.

11 posted on 11/30/2008 2:02:04 AM PST by neverdem (Xin loi min oi)
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To: neverdem

I have. I’m not aware of any muscle issues so far. I’m not super active (work in front of a computer endlessly) so I don’t know if that might hide the symptoms.


12 posted on 11/30/2008 2:18:42 AM PST by DB
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To: neverdem

What are other ways to replace lost potassium (due to diuretics) without eating bananas?


13 posted on 11/30/2008 4:07:27 AM PST by Right Wing Assault ("..this administration is planning a 'Right Wing Assault' on values and ideals.." - John Kerry)
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To: neverdem; DB
Sounds like the study is ALLHAT and NO CATTLE.

Sorry - I just couldn't help myself.

14 posted on 11/30/2008 5:08:03 AM PST by Hardastarboard (0bama IS a socialist - I don't care what the elite media poofters say.)
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To: Right Wing Assault

Potatoes and lima beans are high in potassium.


15 posted on 11/30/2008 5:24:40 AM PST by alnick
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To: Right Wing Assault
I'm hooked on apple juice. Some brands have 8% of daily requirement in an eight ounce serving. A couple of servings prevent my nocturnal cramps. This provides a much higher dosage than expensive pills. Eat fruits and vegetables. I have to provide my nursing mother cows supplemental minerals during the winter months when the green grass is gone. Otherwise they die. So, eat either dirt or the things that grow from it. I send samples of my dirt to Texas A&M twice a year for test to be sure that the nutrients are there to be taken up by my grass and ingestested by the cows.

Do not trust lab tests that indicate you are in the normal range. These test blood serum levels. I always test normal except on an, hardly heard of, intracellular test that I fail.

16 posted on 11/30/2008 5:52:03 AM PST by barnrat
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To: neverdem

bookmark


17 posted on 11/30/2008 5:57:09 AM PST by LucyJo
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To: neverdem

ping


18 posted on 11/30/2008 6:04:44 AM PST by WaterBoard (Somewhere a Village is Missing it's Socialist.)
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To: neverdem
There's nothing that's convenient.

What do you mean by that?
19 posted on 11/30/2008 9:19:34 AM PST by caveat emptor
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To: neverdem

I’ve been on metoprolol for more than five years. I have benign essential tremor and get a double benefit from it. I would not trade this drug for anything. After nearly 50 years of adrenal agitation, my life is significantly enhanced by the “side effects” of the drug. My only concern is that I am now spilling significant protein and have been for the last 6 months. I’m 55, have had a MIDCAB, DXed DMII at age 36. Been on insulin for 2.5 years. I am not scheduled to see my GP again until April but am thinking about moving that up.

Health is such a roller coaster, but I’m happy to be alive instead of dead, which I would have been not many generations back. Let pharma make their money. They deserve it.


20 posted on 11/30/2008 9:28:54 AM PST by Glenn (Free Venezuela!)
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To: neverdem

I don’t know what you mean about “getting the wrong message”. I was just making a straight-forward observation from the first chart that beta blockers are not prescribed as frequently as the others, nothing really to do with the study.


21 posted on 11/30/2008 9:49:22 AM PST by steve86 (Acerbic by nature, not nurture™)
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To: Right Wing Assault
What are other ways to replace lost potassium (due to diuretics) without eating bananas?

Here are two websites which you may find helpful.

USDA Nutrient Data Laboratory. Contains detailed info on most foods eaten by Americans (alas, no Arugula). The link to "Nutrient Lists" doesn't work, at least on my computer.

That kind of info can be found at:

Linus Pauling Institute Micronutrient Info Center. There's no need for concern that their info might not be reliable because of an association with Linus Pauling (RIP). They are happy enough to be funded by an endowment from his estate, but are a perfectly respectable research institute associated with Oregon State University.

I've used them occasionally for years to find the kind of info you're looking for. They're both relatively straightforward, but feel free to FRmail me if you try them and get stuck.
22 posted on 11/30/2008 10:19:01 AM PST by caveat emptor
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To: neverdem
Report any muscle weakness, pain or tenderness as soon as possible.

It is my experience that most doctors blow off complaints of minor myalgias tied to statin use because they are so common. Frankly, there isn't a lot they can do other than perhaps suggest CoQ10 and continue monitoring enzymes and for signs of rhabdo.

Regarding Pravachol/pravastatin, it is certainly better than nothing as a lower cost tier (at least in my plan) statin. I wonder if the old sales line (it is water soluble in your body and so doesn't cause as many muscle/liver problems) holds up in actual use. I may look at it again myself, as I am getting really tired of the soreness in the upper bicep that high-dose Zocor is causing (the pain is reduced markedly when I stop Zocor and/or take a lot of expensive CoQ10).

23 posted on 11/30/2008 11:36:36 AM PST by steve86 (Acerbic by nature, not nurture™)
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To: DB

Meant to ping you on #23. I am not an MD but was somewhat acquainted with an MD/researcher who was an early promoter of Pravachol (paid) and took it myself.


24 posted on 11/30/2008 11:39:17 AM PST by steve86 (Acerbic by nature, not nurture™)
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To: steve86
If you get pain from using Zocor that's simply because your liver is not metabolizing it at the "normal rate" but rather at the "other normal rate" for the folks whose systems produce an enzyme that slows down the process.

What the pain is coming from is you essentially have an overdose ~ much the same thing happens if you eat grapefruit ~ you simply do not exhaust the drug as fast as your doctor thought you would do.

The "other normal rate" is, so far as I know, unknown, but 20% of the population fall in that category.

You can use other statins with different retention rates. One of them causes no pain ~ that's the one that has no reported affect on Alzheimers too, so I guess you're free to take your risks as you see fit.

The way I handle the pain is I take the normal dose for a few days, then lay off until the pain stops, then wait a day. I can then go back on the statin for several days, and repeat the cycle. Since I'm running an "overdose" during the pain period I know I have at least what the doctor proscribed in my system.

25 posted on 11/30/2008 12:02:58 PM PST by muawiyah
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To: muawiyah
I have tried the cycled dose thing also which does help.

I think the pain in my case has to do with CoQ10 depletion, not with metabolizing of the statin by the liver. I took statins for over 10 years before the pain became noticeable so I don't think it is a genetic thing.

The vitamin definitely helps but it is costing me far more than the statin co-payment by a factor of 4 or 5!

26 posted on 11/30/2008 12:09:35 PM PST by steve86 (Acerbic by nature, not nurture™)
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To: muawiyah

I have wondered whether every-day dosing of statins is really necessary anyway. Research shows that the effects of statin use last for years, so why would skipping a few days here and there matter (except maybe to the pharmaceutical companies).


27 posted on 11/30/2008 12:11:50 PM PST by steve86 (Acerbic by nature, not nurture™)
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To: caveat emptor
What do you mean by that?

There are no drugs that are free of adverse effects for everybody.

28 posted on 11/30/2008 12:32:54 PM PST by neverdem (Xin loi min oi)
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To: neverdem

Diuretics ran me out of potassium so I had to drop them.


29 posted on 11/30/2008 12:48:59 PM PST by ex-snook ("But above all things, truth beareth away the victory.")
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To: Right Wing Assault
Potassium Content Of Foods List
30 posted on 11/30/2008 12:52:22 PM PST by neverdem (Xin loi min oi)
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To: steve86
It can still be a genetic thing. You can go along years and years "asymptomatic" and then BANG it happens.

One good example is "gluten intolerance". Children with the problem usually are diagnosed as having Celiac disease. They constitute about 1% of the population. By the time folks reach their 60s or 70s the percentage rises to 3.5%. Followup studies by Finnish researchers reveal that it is genetic in both cases (1% or 3.5%) but some folks simply don't have a problem until later.

Baldness is another ~ it's "genetic", but moderated by the metabolism of testosterone!

31 posted on 11/30/2008 1:18:47 PM PST by muawiyah
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To: alnick; barnrat; caveat emptor; neverdem

Thanks for the potassium info!


32 posted on 11/30/2008 2:48:41 PM PST by Right Wing Assault ("..this administration is planning a 'Right Wing Assault' on values and ideals.." - John Kerry)
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To: muawiyah

Are you sure Occam’s Razor didn’t cut you while you were shaving this morning? :) Have a good week. I think my problem is basically just dose-related. Probably every person would have myalgia-type symptoms if they took a high enough dose of statins.


33 posted on 11/30/2008 3:23:07 PM PST by steve86 (Acerbic by nature, not nurture™)
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To: steve86
The "dose" medical science says you need is the one your doctor gave you. They came up with the dosages before they discovered that the 20% of us that suffer pain from statins were actually suffering the pain of overdoses from statins.

The "cause" was discovered within the last year. My doctor read the same articles and reports and recommended to me that I go ahead and do what I was doing to relieve the pain until "they" come up with something better.

34 posted on 11/30/2008 3:46:49 PM PST by muawiyah
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To: neverdem

Mr. mm’s blood pressure was starting to climb. The doctor wanted him on medicine for it. Since he has had some serious kidney stones, he’s been seeing a specialist and that doctor told him to help prevent kidney stones, he should go on a low salt diet, under 2,000 mg a day.

It was a bit of an adjustment, but he did it and not only has it helped adjust his blood chemistry to make kidney stones unlikely, the first thing that happened was that his blood pressure dropped to normal. No medicine needed now.


35 posted on 11/30/2008 4:55:19 PM PST by metmom (Welfare was never meant to be a career choice.)
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To: neverdem
There are no drugs that are free of adverse effects for everybody.

That remark does not address the question/request in my comment.
I'll try again.

Got any references to studies similar in size and design which comprise two groups as follows:
1. One group is treated with drugs.
2. The other group uses no drugs - just makes diet and lifestyle changes as recommended by, say, Heart and Stroke Foundation. Participants to keep daily diaries, and tests are made to determine changes, if any, in the parameters tested for.

Thanks again.
36 posted on 11/30/2008 4:59:55 PM PST by caveat emptor
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To: Right Wing Assault

You’re welcome.


37 posted on 11/30/2008 5:01:09 PM PST by caveat emptor
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To: steve86; muawiyah

Just looking for an opinion here, not medical advice per se, but .....

I had blood work done for cholesterol. My cholesterol is high as is my LDL. However, my HDL is quite high and my triglycerides are very low. Not what is supposed to be happening.

I started getting more exercise and my HDL went up even more and my triglycerides went down a bunch more but my LDL basically didn’t change.

Have any of you heard of that, high LDL with great other numbers and ratios?

With the side effects I keep hearing about from statins, I’m really hesitant to go on them and have been putting it off. I plan on contacting my DR and discussing my concerns with him, but am just interested in any other opinions at the moment.

I’ve looked online but found precious little about high LDL and HDL and low triglycerides.


38 posted on 11/30/2008 5:01:59 PM PST by metmom (Welfare was never meant to be a career choice.)
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To: metmom
My labs show high pretty HDL as well but the tricks aren't so great. So I take Flax oil.

I would not hesitate starting a statin.

There appear to be benefits besides the cardiovascular ones, although some are tentative, and in my mind those keep me motivated to tolerate some discomfort.

If I were just starting a statin regimen, and could afford it, I would go with 150 mg daily of CoQ10 from the beginning, hoping it would head off myalgia and myopathy.

I am pretty well convinced of the merits of CoQ10, based both on the fact it is known to be depleted and because it reduces my pain.

From wiki:

Inhibition by statins and beta blockers Coenzyme Q10 shares a common biosynthetic pathway with cholesterol. The synthesis of an intermediary precursor of Coenzyme Q10, mevalonate, is inhibited by some beta blockers, blood pressure-lowering medication,[25] and statins, a class of cholesterol-lowering drugs.[26] Statins can reduce serum levels of coenzyme Q10 by up to 40%.[27] Some research suggests the logical option of supplementation with coenzyme Q10 as a routine adjunct to any treatment that may reduce endogenous production of coenzyme Q10, based on a balance of likely benefit against very small risk.[28][29]

39 posted on 11/30/2008 6:33:57 PM PST by steve86 (Acerbic by nature, not nurture™)
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To: DB

Go to abcnews.com and search for “hadler”, and read some of his articles. Better yet, get one of his books from your local library. Americans are being sold a pack of lies about various medical interventions and drugs, and Dr. Hadler lays out the case against those procedures, tests, and drugs that might cause more harm than good.


40 posted on 12/01/2008 5:43:46 PM PST by Pining_4_TX
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To: neverdem

Thanks for the ping.


41 posted on 12/01/2008 5:48:37 PM PST by GOPJ (The CITI financial dike has sprung 500 leaks - we need an engineer - not more fingers.)
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