Blood Pressure Meds: Pricey Isn't Better

Older Drugs Equally Effective for Initial High Blood Pressure Treatment

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Dec. 23, 2003 -- Doctors favor the pricey high blood pressure drugs -- despite evidence that less-expensive drugs are equally effective.

Beta-blockers and diuretics are inexpensive, effective, and well-tolerated drugs for high blood pressure. In fact, they are recommended as first-line treatment by the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, writes researcher Peter A. Ubel, MD, with the VA Ann Arbor Healthcare System.

His study appears in the current issue of the Journal of General Internal Medicine.

Numerous studies show that these older drugs are just as effective as newer, more expensive ones such as ACE inhibitors and calcium channel blockers, he explains.

"Yet the use of beta-blockers and diuretics has declined steadily in the past 15 years in favor of these newer and more expensive medicines," writes Ubel.

What's Going On?

Doctors may be less inclined to prescribe older drugs because they believe -- contrary to published reports -- that the older medications are either less effective or less tolerated than newer, more expensive medications for high blood pressure, Ubel says.

Also, doctors may be prescribing the newer drugs because drug company heavily promote these newer drugs and this may influence how people perceive these new medications -- and because they provide free drug samples, he explains.

Ubel surveyed 647 primary care doctors in 1997 and 2000. Each doctor was given a hypothetical case of a patient who's medical history included only hypertension, then asked what drug he or she would initially prescribe for high blood pressure.

Doctors were asked about factors that affected their drug choices, such as side effects, stroke or heart attack prevention, or availability of free samples. Also, Ubel asked if they ever provided patients with free sample medications.

He found that their prescription practices did not change much over the three-year period, nor did the advice they gave their patients.

Overall, doctors favored newer, more expensive drugs, such as ACE inhibitors and calcium channel blockers, over the older drugs, reports Ubel:

  • Most effective drug: Physicians perceived diuretics as being less effective at lowering blood pressure than other drug choices. The majority of doctors surveyed choose newer more expensive drugs, such as beta-blockers or ACE inhibitors, as being more effective.
  • Drug with most side effects: Here more physicians chose older medications as being less tolerable than newer ones. In fact, according to the authors, ACE inhibitors tend to have more side effects than diuretics or beta-blockers.
  • Drug most preferred as initial therapy: Most physicians surveyed chose newer more expensive drugs over older less expensive ones.


Most doctors "believed that diuretics were less effective and beta-blockers were less tolerated than other medications," writes Ubel. Moreover, the drugs they prescribed were directly related to free samples from pharmaceutical companies, he explains. Overall, 86% of doctors said they offered samples to their patients.

Those who recommended beta-blockers or diuretics were significantly less likely to offer free samples -- probably because samples of these less-expensive drugs are not available, Ubel says.

With so many high blood pressure drugs available, small differences may be all it takes for doctors to favor one drug over another, he concludes.

SOURCE: Ubel, P. Journal of General Internal Medicine, December 2003: vol. 18.

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