Cheaper Is Better For Blood Pressure Control

Last summer the Women’s Health Initiative toppled the estrogen bandwagon. For years doctors had been told that women needed estrogen after menopause, but the government-sponsored study contradicted years of drug-company research.
Now a huge $120 million government study has created a similar upheaval in the treatment of hypertension and heart disease. Over 40,000 subjects were followed for years to determine the outcome of blood pressure lowering drugs. The scientists found that an inexpensive diuretic was superior to some popular brand-name blood pressure pills.
The pharmaceutical industry has spent billions investigating and promoting products like Norvasc, Cardura, Zestril and Prinivil. For FDA approval, drug companies need only prove a medicine lowers blood pressure more effectively than placebo. They have little incentive to test medications head to head to determine whether they actually improve health.
That’s what makes this government research so important. Instead of just looking at numbers on a blood pressure monitor, scientists determined whether people died or had heart attacks, strokes or heart failure.
Curt Furberg, M.D., Ph.D., chairman of the study steering committee, shared his conclusions: “It’s important to lower blood pressure, but it matters how you do it. The diuretics have three advantages. They are unsurpassed in lowering blood pressure; they are superior in reducing the cardiovascular complications of hypertension; and they are 10 to 20 times cheaper than the newer branded drugs.”
Doctors may be surprised to learn that in this trial the calcium channel blocker Norvasc raised the risk of heart failure. This drug was responsible for a 38 percent increase in this serious health problem. Dr. Furberg estimates that with 10 million patients taking similar drugs, there would be 40,000 unnecessary heart failure events per year.
Americans spend nearly $10 billion annually on calcium channel blockers like Norvasc and ACE inhibitors like Zestril and Prinivil. But Dr. Furberg points out that the huge investment is not producing the desired outcome of saving lives. Inexpensive, generic diuretics are apparently better and may be less likely to cause complications such as heart failure or stroke, especially in African Americans.
Another surprise came out of a different phase of the research. Over 10,000 subjects helped investigators determine whether the cholesterol-lowering drug Pravachol could improve longevity. In contrast to earlier studies, this one showed no significant survival benefit for patients taking this statin-type medicine compared to usual care.
Getting doctors to implement the findings of this study poses an enormous challenge. Readers who would like more information about cholesterol and hypertension, non-drug approaches and a summary of various medications may want our Guides to Blood Pressure Treatment & Cholesterol-Lowering Drugs. To order copies, please send $3 in check or money order with a long (no. 10) stamped (60 cents), self-addressed envelope: Graedons’ People’s Pharmacy, No. BL-677, P. O. Box 52027, Durham, NC 27717-2027.