Inexpensive diuretics were shown to be as good as, or better, than brand name medications.
Why did the Allhat trial have so little impact? That’s a question that a recent NY Times story tried to answer.
For me, the biggest impact was that the drugs that were brand-name during the trial, are now generic. Lisinopril and amlodipine (Norvasc) are on many insurers’ generic tier. Also, I have always found thiazide diuretics to be relatively weak antihypertensives when used alone.
One can learn from this expensive debacle. One is that physician payment mechanisms need to be tied with the results of such comparative effectiveness studies. Nothing influences prescribing behavior like money.
The other is that these studies take so long to complete that the questions being studied are obsolete by the time they’re answered.
topics: allhat, hypertension
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{ 2 comments }
Is it at all possible, patients prefer to 1) not pass out at weddings, making spectacles of themselves; 2) not pee every two hours; 3) not have to eat bananas all day because these old meds waste potassium? Is it possible some blood pressure old prefer an ACE inhibitor will not start their diabetes, or markedly worsen pre-existing diabetes? Is it possible the cost of managing new or unstable diabetes is 100 times more expensive to the taxpayer than brand medication? Is it possible that docs and patients are not corrupt and ignorant, and is it possible, they actually know what they are doing? Is it possible for the NYT and bloggers to balance second guessing by know it all supercilious left wing twits and officious intermeddlers with black boxed counterpoint arguments, like a palate cleanser for the left wing hate speech against doctors and their patients?
Kevin,
I have a somewhat different take. See
http://doctorrw.blogspot.com/2008/12/allhat-hype.html
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