Tuesday, March 14, 2006
Temporarily giving anti-hypertensive medicines to people whose blood pressure is just below the threshold for high blood pressure delays the onset of that disease for only a short time, a new study has found.
Emphasis on temporary, and the influence is minimal at best:
The researchers randomly assigned about 800 people with prehypertension to take candesartan or a placebo for two years. After that, everyone took a placebo for two years.
At the end of four years, 240 people who took a placebo the whole time had developed hypertension -- nearly two-thirds of that group. In the candesartan group, 208 people had become hypertensive.
The average time to development of hypertension in the placebo group was 2.2 years, while it was 3.3 years in the candesartan group. The drug slowed the onset of the disease but not by much.
Most people taking candesartan would not benefit from it but would go on to develop hypertension, anyway. In fact, out of 10 people taking the drug for two years, only one would avoid becoming hypertensive at the end of four years.
The Washington Post writer was smart enough to see through the data and present the story without the positive spin, but the authors of the paper think treating normal blood pressure is "feasible". Sure, beginning blood pressure medication before the onset of actual high blood pressure delays the onset of high blood pressure, but does it make any difference? We don't know. For all we know, the outcome in the end may be just as good if we wait until actual high blood pressure develops before we start medication. We've got enough real disease in this world to keep us busy without pushing treatment on the undiseased, thank you.
posted by Sydney on 3/14/2006 09:34:00 PM 8 comments
Unlike you, many doctors see this as a real boon. People are catching on to statins or are just tired of hearing about them. This along with diabetes will give them a reason to bring in their relatively healthy, well insured patients, for more test and monitoring. Don't worry the insurance will pay and the patient's time has no value.
By 7:57 AM, at
"A patient is a well person whose diagnostic workup is not yet complete."
By 8:35 AM, at
In my darker moments, I wonder if the profit motive isn't driving a lot of this, but in truth I think that the people who push this are really working for ways to limit disease as much as possible. They get carried away in their enthusiasm, though, when they embrace pre-disease states.
Last time I checked every medication can/does have negative effects, so is it really such a good idea to start every healthy person out there on them? Does the perceived improvement in long-term health truly outweigh the known morbidities that would occur if every adult in the US with "prehypertension" started taking these meds?
As more and more people owe their livelihood and their careers to publishing more papers and selling more pharmaceuticals, we're going to see more of this. There are more media sources out there looking for more and more stories. In the end, doctors and patients are going to have to do more thinking about what is relevant and what is not.
By 11:41 AM, at
And another thing....
The side effect issue bugs me as well or rather how authors of the guidelines are quick to say "the side effects are rare" or minor. When the person is actually ill, the side effects may well be minor or rare, but when the person is healthy even minor side effects are important. For some reason nobody seems to make this distinction. Fosomax effect of jaw death is indeed extremely rare and other side effects are mild, especially for old women with osteoporosis who don't have much teeth left, but when somebody prescribes it to a 50- year old who only has mild osteopenia, this may well be another story.
By 10:28 PM, at