The Minimal Impact of a Big Hypertension Study

[groovedaddy]

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.”

http://www.nytimes.com/2008/11/28/business/28govtest.html?th&emc=th

[Celebration]

1. there are some really good herbal diuretics as well

Juniper, dandelion, etc. etc. They are really cheap. But, you know, the drug reps aren't selling those or the diuretic meds. They probably aren't giving free samples, and the names aren't being flashed in front of the doctors or the public. More expensive and newer is better--it's not just about the studies or science. There is a little "high fashion" mixed in.

[Fire_Medic_Dave]

2. I'd rather take a drug without the pesky side effects of diuretics.

[semillama]

3. but what if you have a really long name to write in the snow? n/t

[Fire_Medic_Dave]

4. I guess that's a beneficial side effect.

[trotsky]

5. LOL

:thumbsup:

[hvn_nbr_2]

6. Are there bothersome side effects besides loss of potassium?

I haven't read the insert on my diuretic in awhile since I hadn't had any side effects other than loss of potassium. Low potassium can be a serious side effect for me, but since my diuretic dose is pretty low, I can deal with it just by eating more fruits and veggies, which I like anyway.

I do sometimes wonder about long-term effects. Such as, does long-term use have any bad effects on kidneys?

[Heddi]

7. The only long-term side effect I've seen with pts that take diuretics

is that after a while, they just stop being as effective. First they're on Spironolactone. Then they're on Lasix. Then Bumex. Then they have to get on IV lasix because the by-mouth version doesn't work. Then that stops working and they're on Bumex. Then that stops working and........

Of course, I'm a hospital nurse, so I generally am seeing people who have multiple MULTIPLE health problems all at once, who are old, and who have been taking medications for years, generally not-compliant for whatever reason.

And even the lack of effectiveness over time isn't a 100% thing. I mean, based on the patients i've seen it' relatively rare, but we do have the people who have SUCH uncontrollable BP IN ADDITION TO unrelenting Congestive heart failure....you listen to their lungs and it sounds like they're underwater.

Of course, people with kidney failure or dialysis have limited use of diuretics b/c of the kidney component. Doesn't really make sense to take a medication that makes you pee when you, functionally, cannot pee.

[Fire_Medic_Dave]

9. I was only talking about having to piss alot.

[Heddi]

8. One problem I have with this report

is that the fact that our bodies create high blood pressure due to different reasons wasn't discussed. THAT is why diuretics work great for some people (high blood pressure because of fluid retention or heart failure) and CCB's are good for others, and Beta Blockers good for others.

My husband has high blood pressure that has been treated with medication since he was 23 or so. He's not overweight. He doesn't smoke. He exercises. We eat no extra salt and buy low-salt everything. He has been tried on every class of medication in the last 12 years and the only medication that makes any dent in his blood pressure is Beta Blockers. Diuretics didn't work because he's not fluid overloaded. Calcium Channel Blockers didn't work because his HTN problem didn't lie within that area. Ace Inhibitors didn't work because his renin-angiotension-angiotensinogen system worked fine.

I would have liked at least a bit of an explanation from the author that blood pressure issues for me aren't the same as blood pressure issues for you, that there are many reasons why people have HTN (hypertension, high blood pressure). Is it chemical? Is it physiological? Is is stress? Someone who has HTN from stress won't see the results with a diuretic because their HTN isn't caused by fluid retention. Just like someone with an EF of 10% (a sign of very bad and very end-stage heart failure) won't see a decrease of their blood pressure by taking a valium. The cause of the HTN is completely different and therefore calls for completely different pharmacological responses.

[hvn_nbr_2]

10. That pretty much agrees with my understanding.

I've heard in recent years that some people just don't eliminate sodium effectively, and those are the ones that diuretics work well for. People who eliminate sodium well just get rid of any extra so they don't need a drug to help with that.

The "one drug fits all" attitude of this study is bothersome. Maybe that's part of why it hasn't caught on as they expected. I would have expected that use of diuretics would increase after the study, but I have no idea how much it could have been expected. When my doctor and I decided that I needed medication, the first default choice was diuretics, so at least in some medical circles, what this study says they should do is already the standard.

[Heddi]

11. They did the same for my husband

Put him on a low-dose diuretic and it didn't work. Dried him out. He wasn't fluid overloaded---shit, to look at him, you wonder how he doesn't go slipping down the bathroom drain when he takes a shower.

For the record---hubby and I are cardiac nurses, so we see tons of people on all kinds of medications for whatever reason. And I can tell you that it's pretty easy to spot someone who needs a diuretic for blood pressure. You'll show signs of water retention: puffiness, barely audible heart murmur, coarse breath sounds, pitting edema.

I agree with your last paragraph. This would be a wonderful thing if everyone's HTN could be solved by diuretics. But it can't be. That's why Beta Blockers are the only thing that works for my husband. Calcium Channel, Diuretics, Ace Inhibitors, ARB's...none of them worked on him because his HTN wasn't caused by the physiology affected by those medications.

I am finding more people on low-cost beta blockers like lopressor and atenolol for BP these days. It is generally well tolerated in people.....except for the little old ladies who forgot that they took their pill, forgot that they took another pill, and then forgot that the took a 3rd and come into the ER with a heart rate in the 30's......

[Fire_Medic_Dave]

12. Angiotensin 2 Receptor Antagonists have worked great for me.

They were also the first thing my doctor tried. No side effects for me just lower blood pressure and fewer head aches.

David