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Fed Ads Touting Cheaper Drugs / Diuretics Study Done Here Details Benefits for Hypertension
By Eric Berger,
Houston Chronicle Medical Writer Staff
When a massive, Houston-based study of
high blood pressure medicines ended in late 2002, researchers
had good news for patients: The cheapest drugs, diuretics,
were the best option for most people.
But the word hasn't reached all U.S. doctors or the estimated
50 million Americans with hypertension who need medicine.
So the federal government, which helped fund the hypertension
study with a $102 million grant, is stealing a page from
the large drug companies.
In an unprecedented step, the National Heart, Lung and Blood
Institute will spend nearly $4 million over the next two
years to promote the results of its study with a marketing
campaign of its own.
When a pharmaceutical company completes research with favorable
results for one of its drugs, the company's marketers flood
physicians with the news, and they often mount a print and
television advertising blitz to drive patients to their doctors.
But with the conclusion reached by the hypertension study,
no drug company stood to gain by selling generic forms of
diuretics at a fraction of the price of their patented drugs.
So the government is actively encouraging many of the 600
physicians who participated in the study to spread the word
among their colleagues and will also initiate a campaign
of public service announcements and printed materials for
consumers.
"This is an effort to try and get the message out," said
Dr. Barry Davis, a principal investigator of the landmark
study and professor of biostatistics at the University of
Texas School of Public Health at Houston. "It's akin
to the same thing that the drug companies do."
The nearly decade-long study compared the effectiveness
of diuretics with two newer treatments, calcium channel blockers
and ACE inhibitors, in controlling blood pressure and reducing
adverse health effects such as stroke, heart attack and heart
failure. More than 42,000 patients were enrolled in the study
at 623 health centers across the United States.
The authors concluded that because of the superiority of
diuretics in preventing some of the health problems, and
their lower cost, they should be the first step doctors take
in treating hypertension. Also, the researchers concluded,
diuretics should be included in nearly all multidrug regimens
to treat hypertension.
Although this has sparked a moderate move toward diuretics,
the hypertension study authors say, more than three of every
four prescriptions for high blood pressure patients still
are written for the costlier drugs.
The most-prescribed brand-name drug to treat hypertension,
the calcium channel blocker Norvasc, costs $1.50 to $2 for
a once-a-day pill at most pharmacies. By comparison, diuretics
can cost 10 cents a day for generic brands.
Pfizer, the pharmaceutical company that sells Norvasc, emphasizes
the parts of the new public information campaign that urge
more people to get control of their blood pressure and notes
that two or more drugs often are best for that purpose. From
the company's perspective, it is a good thing if more people
visit their doctors to treat their high blood pressure.
The effort to disseminate the hypertension
study results were not "at odds" with Pfizer's
marketing efforts, the company said.
"We believe in people being educated and getting information," said
Dr. Dahlia Garza, medical director of Pfizer's cardiovascular
group. "This trial demonstrated that most patients will
need multiple medications to achieve their blood pressure
goals."
The $3 .7 million grant will go to University of Texas at
Houston, which will then share funds with other health centers.
It is the first such dissemination project of its kind for
a large clinical trial, and participating physicians hope
it will set the standard for the future.
The decision by the National Institutes of Health to aggressively
promote the study results comes amid a sense of frustration
among members of Congress, who fund the research only to
see it have little effect, doctors say.
"We've seen a lot of trials, done at taxpayers' expense,
come out with some pretty striking results that clearly indicate
a need for a chance in practice," said Dr. Paul Whelton,
senior vice president for Health Sciences at the Tulane University
Health Sciences Center and chairman of the hypertension study's
dissemination committee. "But then darn little happens."
No longer will publishing a paper or presenting the results
of major studies at conferences be enough, the government
says. Many practicing doctors do not have time to attend
conferences or carefully read all the medical journals.
And the National Heart, Lung and Blood Institute has decreed
that all new grant applications must now include a new section—a
proposal for wider dissemination of results.
About the Study
The federal government is expanding efforts to inform doctors
and patients that diuretics—older, cheaper medications
for treating high blood pressure—should be the first choice
for most patients. The recommendation is based on a landmark
study completed 14 months ago. The trial:
Was based at the University of Texas School of Public Health
at Houston.
Was funded in part by a $102 million grant from the National
Heart Lung and Blood Institute.
Compared diuretic therapy for high blood pressure against
two costlier types of drugs.
Involved 42,418 high blood pressure patients from across
the United States.
Concluded that diuretics are more effective at preventing
heart attacks and should be prescribed first for nearly all
patients.
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