Episode 8: Taking the Pressure Off: Hypertension Drugs
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In our eighth installment, we discuss the initiation of hypertensive drug therapy. In recommending thiazide diuretics, we outline the evidence (e.g. ALLHAT trial) showing equivalence and the significantly lower yearly cost. We debate (politely this time) dosing and attempt to dispel the smokescreen of thiazide metabolic issues (e.g. blood glucose).
Comments
A patient with BP 160 may not
A patient with BP 160 may not be impressed by 1% reduction stroke but what are his or her chances of ESRF and CCF. Are there any studies showing treating BP reduces ESRF and heart failure.
Hi: In the very first
Hi: In the very first hypertension trial (VA 1967) with average diastolics of 121 mmHg only 2 of 70 placebo recipients developed a worsening of renal function over 2 years - in the UKPDS (type 2 diabetes) less than 1% of subjects went on to dialysis over 8 years - I am unaware of any studies showing BP treatment decreases the chance of ESRD - I think it is because the overall incidence of ESRD is so low that even if there is a benefit a study won't pick up any benefit if there is one. If anyone has any other evidence please let me know. Thanks.
As a family physician I'm
As a family physician I'm always telling my patients my mantra that 'less drugs is better', so I really like your approach. My first contact with you guys actually was as during residency at a small conference in Peace River where Mike asked you to come out to speak on several of the issues you discuss in the podcasts.
Here's my dilemma in sorting the evidence: Our "long term" drug trials only ever go out to 5 years in most cases, 10 in some. Is it a fair assessment to use modest benefits in mortality or morbidity over these short time periods to decide that the benefit isn't worth the drug, when the real benefit of, say, HTN treatment today, is likely in 20 or 30 years rather than in 5 years?
Great show.
Hypertension: Drug therapy: A thiazide sure but not any thiazide
Hi,
I will love to hear a mesmerizing update from you about HBP drug therapy, specially after this astonishing meta-analysis (Messerli F, Makani H, Benjo A, et al. Antihypertensive efficacy of HCTZ as evaluated by ABPM. A meta-analysis of randomized trials. J Am Coll Cardiol 2011; 57:590-600.). I checked the data here in Canada (IMS health), it appears that the family physician prescribe a lot of HCTZ (Apo-Hydro within the 10 top most prescribed drugs by FP's)despite that ALLHAT was conducted with chlorthalidone.
Thank you very much for your work
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