Doctors React To Bad News About Drugs Study On Hypertension Drugs Surprises Cardiologists

A TV news report stopped Spokane heart doctor Donald Canaday in his tracks as he exercised at home last Friday.

A new study had linked a hypertension drug - one he prescribes for hundreds of patients - to an increased risk of heart attack.

“Oh no,” thought Canaday. “Wait until Monday morning!”

But patients taking calcium channel blockers didn’t wait until then to track down their doctors.

On-call cardiologists spent much of last weekend calming frantic patients and digging up data on the study done by a University of Washington researcher.

It’s a chronic problem for doctors: Patients learn about medical studies and breakthroughs from the media, often before anyone tips off the doctors.

Douglas Wysham was one of those on-call doctors flooded with calls. A worried patient paged him early Saturday as he made hospital rounds.

“I don’t know what you’re talking about,” he told the woman.

“We didn’t know what they were all excited about, because we hadn’t seen it,” said Wysham, who works at Rockwood Clinic. “Patients were sending us copies that ran in their local newspapers.”

Doctors long have been accustomed to acclaimed medical journals making public important studies before the journal is published.

This time, not only were they unaware of the study, many don’t agree with the results and the way they were reported.

Some doctors contend their patients with high blood pressure are in no danger at all. Quitting the medication is riskier than taking it, they say.

Other larger studies have shown the drugs to be safe, said Terrance Judge, a Spokane cardiologist who got about 50 calls from concerned patients.

“I first heard about it Friday night (on television),” Judge said. “I spent the weekend trying to find where it was published.”

Judge said he doubts calcium channel blockers are dangerous, but he advised people who are extremely worried about the drug’s safety to stop taking it.

“Now we need to change your medication because you’re afraid of it, not because of some scientific reason,” he said.

Judge said he’s spent too much time this week practicing “damage control” instead of medicine.

The Spokesman-Review didn’t print an article about the study’s findings, which were released at the annual meeting of the American Heart Association in San Antonio, Texas.

However, the issue appeared in many regional and national news reports.

Those reports said patients taking the drugs may boost their risk of heart attack by 60 percent, compared with people taking other typical high blood pressure medications.

The Seattle researcher, Bruce Psaty, explained it this way: If 1,000 patients were treated with diuretics or beta blockers for one year, about 10 would be expected to have a heart attack in that year. If those patients instead took calcium channel blockers, about 16 would have a heart attack.

Efforts to reach Psaty Wednesday were unsuccessful.

Wysham and Judge said the news stories were misleading and sensational.

Judge also criticized the study as being retrospective - done by studying patient records - rather than by following patients currently taking the drugs.

“None of the larger, betterdesigned studies have ever shown this,” said Judge. “It’s a unique finding.”

“It’s not that the doctors object to information getting out in the media,” said Wysham, “but this is potentially wrong information.”

Calcium blockers are believed to lower blood pressure by blocking the movement of calcium ions across cell membranes, thereby relaxing muscle cells around blood vessels and allowing them to dilate.

The calcium channel blockers evaluated in the Seattle study are nifedipine, diltiazem and verapamil, sold under the brand names Adalat, Calan, Cardizem, Dilacor, Isoptin and Verelan.

The immediate risk of a heart attack is low regardless of treatment, Psaty wrote in a statement released to doctors and patients Monday.

“For drugs that are used by many people for many years, this difference would be important from the point of view of public health in the long term,” he wrote.

Psaty urged concerned patients to stay on their medications and discuss the issue with their doctors.

“No patient,” said Judge, “should be unduly frightened by this study.”