Hypertension was first recognized as an important risk factor for heart disease, strokes and renal (kidney) failure in the 1950s. The key question at...
Hypertension was first recognized as an important risk factor for heart disease, strokes and renal (kidney) failure in the 1950s. The key question at that time was: If you lower blood pressure with medications, could you decrease these events?
People with hypertension were randomly assigned either to receive a blood-pressure medication or a sugar pill, and were not told which group they were in. It became quickly evident that not only did blood-pressure medications decrease heart disease, strokes and kidney failure, but also decreased deaths.
The effectiveness of these pills was not small — 33 percent fewer heart attacks, strokes and deaths occurred. Furthermore, almost any type of blood-pressure-lowering medication saved lives.
Fast-forward to today. One out of three American adults has hypertension. Studies show the oldest medicines, water pills (diuretics), are somewhat more effective than other types of newer medications, and are also very cheap, pennies a day, and for the most part safe. Almost every hypertension-medication-treatment guideline recommends diuretics first.
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The problem with this simple formula is that the average person with hypertension needs to take two to three medications to control their blood pressure. So, more expensive, newer medications are added.
The opening segment of The Seattle Times’ “Suddenly Sick” series (page one, June 26-30) focused on hypertension. Many good points were made about the negative influences of pharmaceutical companies. However, some of the information was oversimplified and could lead patients with hypertension not to take their medications and risk becoming suddenly sick.
One of the June 26 stories reports that a woman with hypertension who is given a newer, more-expensive medication, lisinopril, has an allergic reaction, her airways swell shut, and she almost dies. What is not mentioned is that this is a known side effect that occurs in about 1 percent of patients, and physicians and pharmacists warn patients of this potential. If this side effect occurs, it is easily treatable, and death is extremely rare. A patient with hypertension who tolerates lisinopril well — and the vast majority do — is tremendously better off with it, than without it.
Also not mentioned is that lisinopril is the best drug we have to prevent renal failure in patients with diabetes, and patients with heart disease who take lisinopril are much less likely to get a second heart attack or heart failure, or to die from heart disease.
People don’t feel sick when we ask them to take these medications, so they need to trust they will benefit by complying. Reading the package insert that comes with medications would be daunting enough; adding concerns about pharmaceutical company “plots” further erodes that needed trust.
Drug companies have tremendous marketing power in the United States. Government agencies, health plans and physicians are well aware of this. In the health-care organization I work at, Group Health Cooperative, these issues are of great importance. Our mission is to improve health-care outcomes — and to do this responsibly, without our enrollees bearing unreasonable costs.
We have guideline and pharmacy committees that review hypertension recommendations regularly, check for bias in studies (including the presence of pharmaceutical company support), and quickly disseminate the most up-to-date and accurate information to our physicians.
Furthermore, we have electronic medical records that ensure that patients are not prescribed medications they are allergic to or that interact with other medications. If physicians want to order a hypertension medication that is not on our preferred list, they are reminded of what the preferred list is. This check and balance assists them in giving the best care, based on research, but also allows them to individualize care for patients who might have good reason to need a more-expensive or less-studied drug.
I applaud The Times for taking on the serious issues that are raised over pharmaceutical influence on health expenditures and the potential for overtreating patients without benefit.
It is also important for people to understand that it is the job of health plans and physicians to sort these matters out and assure patients receive the most efficacious drugs possible, with the least risk and the most potential for gain.
Before patients become unnecessarily alarmed and stop using life-saving drugs, they should review these issues with their personal physician.
Dr. Beverly B. Green is the associate director of the Department of Preventive Care at Group Health Cooperative and an assistant clinical professor at the University of Washington. She chairs the Group Health Hypertension Committee and is a co-primary investigator on a National Institutes of Health-funded grant to improve hypertension control. She receives no money from pharmaceutical companies.