Avanzini F, Alli C, Corsetti A, Colombo F, Tognoni G for the
STAR Study Group
Appropriate antihypertensive therapy in current practice.
Results of a feasibility study
12th Annual ASH Meeting
Am J Hypertens
(Apr) 10:141A 1997
This study was designed to assess the feasibility of using
clinical guidelines to improve blood pressure (BP) control while
using less expensive drugs with documented preventive efficacy
(i.e., diuretics and beta-blockers).
Forty-eight physicians
agreed to test these guidelines in their daily practice. 1130
hypertensive patients (H) were studied (62% F, mean age 64 ± 12
y, range 26-94 y). At study onset 93% were treated with
antihypertensive drugs (48% with diuretics, 22% with
beta-blockers, 37% with calcium antagonists, 53% with ACE
inhibitors, 3% with alpha-blockers and 4% with other drugs).
Systolic BP was < 140 mmHg and diastolic BP < 90 mmHg in only 23%
and 62% respectively and 11% of patients did not tolerate their
drug regimen.
During the 12-month study period 26 patients (2%)
died, 31 (3%) dropped out and 1073 (95%) completed the study.
During this period there was: a) an increase in diuretic and
beta-blocker use (from 48 to 57% and from 22 to 31%) and better
control of both systolic BP (< 140 mmHg from 23 to 41%) and
diastolic BP (< 90 mmHg from 62 to 87%). Drug tolerance also was
noted to improve. Although the mean number of antihypertensive
drugs per patient rose slightly (from 1.67 to 1.70), the mean
cost decreased by 9%. These data suggest that use of
antihypertensive drug guidelines can improve the efficacy, safety
and costs of therapy.
Comment: This is a non-randomized feasibility study which
suggests that antihypertensive drug guidelines that favor the use
of diuretics and beta-blockers can improve efficacy and safety
decrease cost. It is clear that diuretics and beta-blockers have
time-tested efficacy and are inexpensive. However, I am
personally skeptical whether patients will tolerate diuretic and
beta-blocker regimens better (or even as well) than regimens
employing newer agents. For instance, several quality of life
studies including the landmark captopril study
(Croog SH, et al.
N Engl J Med 1986; 314: 1657) have indicated that beta-
blockers
are less well tolerated than newer agents.
(David J. Leehey, M.D., Loyola University at Chicago)
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12th Annual ASH Meeting
H: Drug therapy :
Compliance
H: Drug therapy :
Multiple drugs, synergy