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medpundit |
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Friday, February 14, 2003A better question would be which media spin to believe. As pointed out in these pages, the first study really didn’t show much difference in outcomes between the two types of drugs. The same can be said of the most recent study. The study looked at blood pressure control in patients taking the diuretic hydrochlorothiazide and in those taking the ACE inhibitor enalapril. (Not the same drugs used in the earlier American study, by the way.) At the end of four years, here’s what they found for blood pressure readings in the two groups: At year 1, blood pressure had decreased by 20/9 mm Hg in the ACE-inhibitor group and 22/9 mm Hg in the diuretic group; at year 2, it had decreased by 23/10 mm Hg in the ACE-inhibitor group and 24/10 mm Hg in the diuretic group; and at year 5, it had decreased by 26/12 mm Hg in both groups. No difference there. But it isn’t superior blood pressure control that the authors claim for the ACE inhibitors, it’s a superiority in preventing death and heart attacks. Turns out there isn't much difference in that respect, either. Among the ACE-inhibitor patients, 695 out of 3044 (23%) either died or had a cardiovascular illness (heart attacks, strokes, angina requiring treatment, or heart failure) during the study. For those treated with diuretics the figure was 736 out of 3039, or 24%. Separating deaths and cardiovascular illnesses doesn't improve the numbers. Six percent of those on an ACE inhibitor died during the study, compared to seven percent of those on a diuretic. Thirteen percent of those on ACE inhibitors had a first-time cardiovascular event; fourteen percent of those on diuretics. That one percent difference might mean a lot to someone who deals with populations, but it doesn’t mean squat when you’re dealing with an individual patient. All things being equal, given the choice between a $5 a month pill whose users have a 24% incidence of death or cardiovascular illness, or a $34 a month pill whose users have a 23% incidence of the same, most people would choose the $5 a month prescription. (At least they would if they had to pay the bill themselves.) The moral of the story is that diuretics and ACE inhibitors are equivalent when it comes to their effectiveness in lowering blood pressure as well as their influence on mortality and cardiovascular morbidity. Neither study has made a strong argument to favor one drug over the other, which means that physicians should still choose blood pressure therapy based on what's best for their individual patient, not on the latest media spin of the latest study. UPDATE: DB has some things to say about this, too. posted by Sydney on 2/14/2003 06:11:00 AM 0 comments 0 Comments: |
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