Cheaper Blood Pressure Drugs Better, Says Report

Doctors are increasingly prescribing high blood pressure drugs that cost hundreds of millions of dollars a year more than cheaper drugs that should be the first option, a new report says.

The increased use of the more costly drugs and declining use of the cheaper drugs had been reported through 1993 in earlier research. The new study extended the analysis to learn whether federal guidelines issued in 1993 altered the trends.

The cheaper alternatives, diuretics and beta blockers, were recommended as first-choice treatments for hypertension in 1993 by the Fifth Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure.

The committee, a panel of experts convened by the National Heart, Blood and Lung Institute, said the cheaper drugs are the only ones that have reduced deaths and illnesses from heart disease, authors noted in Wednesday’s issue of the Journal of the American Medical Association.

But prescriptions have continued to soar for the more costly drugs, calcium antagonists and angiotensin-converting enzyme (ACE) inhibitors, said the authors, Dr. David Siegel and pharmacist Julio Lopes of the Department of Veterans Affairs, Northern California Health Care System, in Martinez, Cal.

Calcium antagonists rose from 33 percent to 38 percent of all high blood pressure drugs prescribed from 1992 to 1995; ACE inhibitors increased from 25 percent to 33 percent in the same interval, authors said.

Meanwhile, beta blockers dropped from 18 percent to 11 percent and diuretics from 16 percent to 8 percent, suggesting the new federal guidelines had little effect on prescribing, they said.

The authors did not do a financial analysis but said that differences in the costs of calcium antagonists vs. diuretics alone was hundreds of millions of dollars per year nationwide in 1995.

Doctors may prefer the more expensive drugs for several reasons, authors said. In some trials, the cheaper drugs produced less-than-expected reductions in heart deaths, they said. Also, many patients need treatment for other conditions, including congestive heart failure, for which ACE inhibitors are most effective.