NIH promotes use of lower cost drugs for hypertension
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《英国医生杂志》
Quebec
Dr Paul Whelton is worried because doctors are not implementing trial findings
Credit: IAN JACKSON/WESTERN MORNING NEWS
The US National Institutes of Health is planning to use some 600 prominent doctors in the United States, Canada, and Puerto Rico to promote the use of lower cost drugs to treat hypertension.
Currently, the cost of antihypertensive drugs in the United States amounts to about $15bn (￡8bn; 12bn), accounting for 10% of the country's total spending on drugs. The institutes' $3.7m initiative is the first time it has tried to promote a change in doctors' prescribing habits.
A study in JAMA in 2002 showed that diuretics could be more effective as hypertension treatments than angiotensin converting enzyme inhibitors or calcium channel blockers and at much lower cost ( JAMA 2002;288: 2981-97). The study, known as the antihypertensive and lipid lowering to prevent heart attack trial (ALLHAT), was followed later by updated recommendations to doctors through a consensus process called the joint national committee reports.
Dr Paul Whelton, senior vice president for health sciences at Tulane University's Health Sciences Centre, New Orleans, and one of the principal authors of the JAMA report, said that the study had presented the findings of the largest trial ever carried out in the treatment of hypertension. Yet its impact, and that of a more recent joint national committee report (the seventh), had been disappointing.
He said that he and many colleagues are disturbed at this lack of impact and will use the NIH initiative to try to ensure that practitioners and the general public are aware of, and will implement, the most current findings of the best research.
"It's the first time in the wake of a big trial that we've tried to do this. And largely it's because we've learned from past experience that we were not successful," he told the BMJ.
The strategy will be, firstly, to encourage doctors who participated in the JAMA study—who are often influential in their community—to make their colleagues aware of the study's findings and their implications for practice; secondly, to work with those who oversee formularies and thus have great influence on the availability of drugs; and, thirdly, to use public service announcements and printed materials to publicise study results.
The need for the NIH initiative was underlined by a study presented on 4 March to the annual conference of the American Heart Association that showed that spending on antihypertensive drugs more or less doubled between 1990 and 2002, rising from about $6bn to $12bn.
One of the main reasons was because doctors selected the more costly antihypertensive agents (angiotensin converting enzyme inhibitors and angiotensin receptor blockers) rather than diuretics. The increase in the cost of the drugs (rather than the amount prescribed) accounted for 32% of the overall rise.(David Spurgeon)
Dr Paul Whelton is worried because doctors are not implementing trial findings
Credit: IAN JACKSON/WESTERN MORNING NEWS
The US National Institutes of Health is planning to use some 600 prominent doctors in the United States, Canada, and Puerto Rico to promote the use of lower cost drugs to treat hypertension.
Currently, the cost of antihypertensive drugs in the United States amounts to about $15bn (￡8bn; 12bn), accounting for 10% of the country's total spending on drugs. The institutes' $3.7m initiative is the first time it has tried to promote a change in doctors' prescribing habits.
A study in JAMA in 2002 showed that diuretics could be more effective as hypertension treatments than angiotensin converting enzyme inhibitors or calcium channel blockers and at much lower cost ( JAMA 2002;288: 2981-97). The study, known as the antihypertensive and lipid lowering to prevent heart attack trial (ALLHAT), was followed later by updated recommendations to doctors through a consensus process called the joint national committee reports.
Dr Paul Whelton, senior vice president for health sciences at Tulane University's Health Sciences Centre, New Orleans, and one of the principal authors of the JAMA report, said that the study had presented the findings of the largest trial ever carried out in the treatment of hypertension. Yet its impact, and that of a more recent joint national committee report (the seventh), had been disappointing.
He said that he and many colleagues are disturbed at this lack of impact and will use the NIH initiative to try to ensure that practitioners and the general public are aware of, and will implement, the most current findings of the best research.
"It's the first time in the wake of a big trial that we've tried to do this. And largely it's because we've learned from past experience that we were not successful," he told the BMJ.
The strategy will be, firstly, to encourage doctors who participated in the JAMA study—who are often influential in their community—to make their colleagues aware of the study's findings and their implications for practice; secondly, to work with those who oversee formularies and thus have great influence on the availability of drugs; and, thirdly, to use public service announcements and printed materials to publicise study results.
The need for the NIH initiative was underlined by a study presented on 4 March to the annual conference of the American Heart Association that showed that spending on antihypertensive drugs more or less doubled between 1990 and 2002, rising from about $6bn to $12bn.
One of the main reasons was because doctors selected the more costly antihypertensive agents (angiotensin converting enzyme inhibitors and angiotensin receptor blockers) rather than diuretics. The increase in the cost of the drugs (rather than the amount prescribed) accounted for 32% of the overall rise.(David Spurgeon)