Millions Wasted on Blood Pressure Drugs

But Cheaper Diuretics Are Being Used More Often, Expert Says

From the WebMD Archives

Sept. 8, 2003 -- Americans may be wasting up to a billion dollars a year by choosing newer, more expensive high blood pressure medications over older and cheaper drugs.

That was the finding from an international cost analysis, which calculated the potential annual savings of treating patients with water pills, or diuretics, instead of newer high blood pressure medications such as beta-blockers, ACE inhibitors, and calcium channel blockers.

But an expert who is tracking the use of diuretics for high blood pressure control tells WebMD that the pendulum is swinging back toward the less expensive drugs.

Hats Off to Water Pills

Diuretics were all but ignored in the U.S. as a first-line treatment for high blood pressure until recently, due to a widely held belief that the newer drugs worked better. But a landmark, government-funded study, released late last year, found the opposite to be true. Participants in the ALLHAT trial taking a common diuretic to control their high blood pressure had fewer heart attacks than participants taking three newer high blood pressure medications.

Tulane University epidemiology professor Paul Whelton, MD, who led the ALLHAT study and now leads a committee that is assessing its impact, says doctors are getting the message and are more often choosing diuretics to control their patients' high blood pressure.

He says just about everyone taking high blood pressure medication should be on a diuretic, either alone or in combination with another type of high blood pressure medication.

Cheap But Effective

"Diuretics are extraordinarily inexpensive, and they work very well," he says. "They are clearly the first-line treatment for uncomplicated high blood pressure.

A year's worth of diuretics cost patients about $25 to $35, compared with about $250 for ACE inhibitors and roughly twice that for calcium channel blockers.

The cost analysis, which was completed prior to the release of the ALLHAT study, found that between $433 million and $1 billion annually could be saved in the U.S. if diuretics were prescribed according to guidelines for high blood pressure control.

Lead researcher Atle Fretheim, MD, tells WebMD, that even though diuretics are the accepted first-line treatment for blood pressure control, many doctors still do not prescribe them. Heavy promotion of the newer, more expensive high blood pressure medications by their manufacturers is one reason, he says.

Too Much Toilet Time

Another is that many doctors still believe patients have more side effects on diuretics, such as frequent urination.

"In the old days, patients on diuretics did spend a lot more time in the toilet, but that is not true today," he says. "The recommended dosages nowadays are so low that there really isn't a diuretic effect."

When the ALLHAT study came out last December, its researchers also estimated that $1 billion could be saved annually if diuretics were widely prescribed as the first-line high blood pressure medication. Whelton says progress has been made toward lowering that figure, but it is not yet clear how big an impact the study has had.

"That is why we are tracking prescriptions and continuing our efforts to get the word out. And our preliminary data suggest that many more patients are taking diuretics."

Show Sources

SOURCES: Biomed Central Health Services Research. Atle Fretheim, MD, researcher, department of health services research, Norwegian Directorate for Health and Social Affairs. Paul Whelton, MD, senior vice-president for health sciences, Tulane University, New Orleans; regional coordinator for ALLHAT study.
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