The Minimal Impact of a Big Hypertension Study

NY Times ^ | November 28, 2008 | ANDREW POLLACK

[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...

[neverdem]

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)

[neverdem]

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.

[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. Also don’t understand why they keep prescribing BBs for my wife when they can worsen diabetes symptoms.

[DB]

Neverdem, are you a doctor?

And if so what is your take on Pravastatin?

[caveat emptor]

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

[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.

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.

[neverdem]

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.

[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...

[neverdem]

There's nothing that's convenient.

All drug classes are problematic.

[Star Traveler]

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...

[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...

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

[DB]

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.

[Right Wing Assault]

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

[Hardastarboard]

Sounds like the study is ALLHAT and NO CATTLE.

Sorry - I just couldn't help myself.

[alnick]

Potatoes and lima beans are high in potassium.

[barnrat]

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.

[LucyJo]

bookmark

[WaterBoard]

ping

[caveat emptor]

There's nothing that's convenient.

What do you mean by that?

[Glenn]

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.