Monday, December 12, 2005

PBS Frontline - didn't make the broadcast

Frontline Dangerous Prescriptions notebook reports on additional problems with hypertension drugs.
About 50 million Americans have hypertension (commonly known as high blood pressure) -- and an estimated 30 million need some sort of medical treatment to bring their problem under control. Patients who fail to lower their blood pressure face increased risk of heart attacks, strokes and diabetes -- so the treatment of hypertension has become one of the largest markets for drugs in America and everywhere else in the developed world.
By some estimates, there are as many as 180 different prescription medications used in the United States to treat hypertension. Almost every major drug company has at least one product for lowering blood pressure, and doctors are generally happy to have these choices. But having so many choices does create a problem. Some drugs are bound to be more effective than others -- so doctors urgently want to know what's best.
Unfortunately, pharmaceutical companies rarely conduct clinical trials that fairly and objectively compare other companies' drugs against their own. And the FDA doesn't conduct such trials either, because the agency is not in the business of doing medical research -- only reviewing the results submitted by pharmaceutical companies.
With Americans spending $16 billion a year on blood pressure medicines, and no objective information to show which ones were most effective at reducing the problems caused by high blood pressure, about 10 years ago the National Heart Lung and Blood Institute (a division of the National Institutes of Health) started a long-term clinical trial that would honestly and fairly compare the effectiveness of the leading types of blood pressure medicines. The study, called ALLHAT (short for Anti-Hypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial) enrolled over 42,000 Americans, lasted for some eight years, and cost over $140 million.....
While all the drugs helped lower patients' blood pressure to about the same degree, according to the ALLHAT results patients on Norvasc -- an expensive and highly-advertised product -- were 38 percent more likely to develop heart failure than patients on the cheap, tried-and-true diuretics. And patients on Lisinopril (also more expensive than diuretics, and just coming off patent) were 15 percent more likely to develop strokes, 19 percent more likely to develop heart failure, and 11 percent more like to have angina than patients on diuretics. So, as a first-line treatment, the cheapest, oldest and least-promoted drug was significantly better at preventing the serious problems that can arise from having high blood pressure.
If you eliminated all the ACE inhibitors and calcium antagonists [calcium channel blockers] for the first-line treatment of hypertension," says Furberg, and if patients were put on diuretics, "we would avert maybe 60,000 events per year -- 60,000 heart failures or strokes. These are devastating complications. So, if you want to know what has happened over the past five years, we'll you can multiply by five. So we're talking about a large number of people who unnecessarily have suffered these events because we didn't have the knowledge we have today.
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After I read this, I asked several people if they took diuretics and they did - but they were also on additional medications.

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