Diuretics and beta-blockers are recommended by the Joint National Commission on High Blood Pressure Treatment as the first-line treatment for uncomplicated high blood pressure. But in the survey of 1,700 primary care doctors, diuretics were rated less effective at lowering blood pressure and beta-blockers were thought to have more side effects than the newer calcium channel blockers and ACE inhibitors.
Further, doctors who favored prescribing the more expensive drugs were more likely to give patients free drug samples from pharmaceutical representatives.
"These new, more expensive medications are being more heavily promoted by the drug companies, and one way or another that information influences how people perceive the drug's effectiveness," says study author Peter A. Ubel, M.D., associate professor of internal medicine at the U-M Medical School and director of the U-M Health System's Program for Improving Health Care Decisions.
The study, published in the December issue of the Journal of General Internal Medicine, presented a hypothetical patient whose blood pressure was 170/105 (anything higher than 140/90 is considered abnormal). The patient had tried to control his blood pressure for a year using diet and exercise but it remained high. He has no other medical problems. Doctors were asked to estimate the effectiveness in this situation of ACE inhibitors, beta-blockers, calcium channel blockers and diuretics. They were also asked what medication they would initially prescribe for this patient.
Despite numerous clinical trials that have shown diuretics and beta-blockers to be equally effective in treating uncomplicated high
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Contact: Krista Hopson
khopson@umich.edu
734-764-2220
University of Michigan Health System
19-Dec-2003