Use Of Low-Cost Diuretics Did Not Increase
The use of low-cost, generic diuretics to treat high blood pressure did not increase significantly following a 2002 study that found the drugs were more effective at treating hypertension than newer drugs that were up to 20 times more expensive, the New York Times reports.
The National Heart, Lung and Blood Institute in 1994 began enrolling high blood pressure patients ages 55 and older in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, or Allhat, to determine whether diuretics or other medications, including calcium channel blockers and ACE inhibitors, were more effective at treating hypertension. More than 42,000 people eventually enrolled in the trial, which cost $130 million, according to the Times. The findings were published in the Journal of the American Medical Association in December 2002.
According to the Times, the experience of Allhat is "worth remembering" as policy experts and government officials call for new studies to compare other treatments. The Times reports that several factors -- including difficulty in persuading physicians to prescribe diuretics, disagreement among medical experts; and pharmaceutical companies' marketing of high blood pressure drugs -- contributed to Allhat's impact. In addition, more drugs are available in generic versions, reducing the cost advantage of diuretics.
Curt Furberg, a public health sciences professor at Wake Forest University who was first chair of Allhat's steering committee, said the "pharmaceutical industry ganged up and attacked" Allhat and "discredited the findings." John Flack, chair of medicine at Wayne State University who was not involved in the study but has been a consultant for drug companies, said Allhat's goal of determining which drug was most effective became an "outdated question that doesn't have huge relevance to the majority of people's clinical practices."
Medical experts have said there are several lessons from Allhat, the Times reports. Robert Califf, a cardiologist at Duke University who served on Allhat's safety monitoring committee, said the study proved that "all trials have flaws" that leave results open to interpretation. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, said that information is "necessary, but not sufficient" to persuade physicians to change their prescribing practices (Pollack, New York Times, 11/28).
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