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Project Goes ‘Door
to Door’ To Promote Blood Pressure Treatment
News
By David R. Bates,
Development
More than a year after announcing that
the first-choice drug for treating high blood
pressure should almost always be a cheaper, older
diuretic, researchers in a landmark clinical study
are launching a campaign to carry that message
directly to patients and physicians.
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| Barry R. Davis,
M.D., Ph.D., professor at the UT School of
Public Health at Houston, is leading a
public information campaign to get the word
out about recommendations for treatment of
high blood pressure.
Photo by Michele Mocco |
Under a two-year, $3.7 million contract, the
Antihypertensive and Lipid-Lowering Treatment to
Prevent Heart Attack Trial (ALLHAT), based at The
University of Texas School of Public Health at
Houston, will immediately begin disseminating the
ALLHAT study findings and recently released
hypertension treatment recommendations.
The public information campaign, supported by the
National Heart, Lung and Blood Institute (NHLBI) of
the National Institutes of Health, will
use a corps of about 200 “clinician-educators” to
meet face-to-face with physicians and professional organizations
nationwide.
“The key is to get the results out to the medical
community and to patients with high blood pressure, so both
can understand and apply the benefits of being on a diuretic
and controlling hypertension,” said principal investigator
Barry R. Davis, M.D., Ph.D., professor of biostatistics and
director of the Coordinating Center for Clinical Trials at
the UT School of Public Health.
Other dissemination strategies will
include public service announcements, print materials,
formulary system modification
and appeals for professional and scientific community influence
in support of ALLHAT’s findings and the latest hypertension
treatment recommendations.
“Many trials, conducted at taxpayers’ expense,
have produced striking results that indicate the need for
a change in clinical practice, but very little happens,” said
Paul Whelton, M.D., senior vice president at the Tulane University
Health Sciences Center and chairman of the hypertension study’s
dissemination subcommittee.
Because of their superiority in preventing one or more major
forms of cardiovascular disease and their lower cost, thiazide-type
diuretics should be the drugs of choice for initial treatment
of hypertension, ALLHAT suggests.
In patients who cannot tolerate a
diuretic, therapy can be started with ACE inhibitors, calcium
channel blockers
or beta-blockers. Most hypertensive patients require more
than one medication to control blood pressure, and diuretics
should be part of most multi-drug regimens. Behavioral approaches – an
eating plan, physical activity and weight loss –also
should be explored.
High blood pressure affects about
50 million Americans, or one in four adults, and its prevalence
increases with
age – more than half of those over age 60 have hypertension.
Studies have shown that controlling high blood pressure can
reduce heart failure by 50 percent, stroke by 38 percent
and heart attack by 28 percent.
“Possibly, we could save 40,000 to 50,000 serious
illnesses per year, including heart failures and strokes,
if people with high blood pressure or those newly diagnosed
with high blood pressure have a diuretic incorporated into
their regimen or started on a diuretic,” Davis said.
Davis said that ALLHAT’s landmark
findings will have a great impact beyond improving cardiovascular
health. As
diuretics generally cost less per pill than the other drugs,
prescribing them first could dramatically reduce health care
costs. Annual U.S. outlays for antihypertensive drugs are
estimated at $15 billion.
ALLHAT is the largest clinical trial of hypertension treatment
ever conducted, involving 42,418 participants aged 55 and
older, at 623 clinical centers across the United States and
in Canada, Puerto Rico and the U.S. Virgin Islands.
“This is the first dissemination project of its kind
for a large clinical trial and hopefully will set the standard
for the future,” Davis said.
Findings of the ALLHAT study appeared in two articles in
the Dec. 18, 2002, issue of the Journal of the American
Medical Association.
Current blood pressure control recommendations
are given in “The Seventh Report of the Joint National Committee
on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure,” (JNC 7) issued by the NHLBI’s
National High Blood Pressure Education Program in 2003.
NHLBI press releases and other materials, including information
about high blood pressure, high blood cholesterol and heart
disease, are available at http://www.nhlbi.nih.gov.
UTHSC-H Distinctions, May 2004.
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