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CALCIUM BLOCKER, ACE INHIBITOR USE INCREASES DESPITE GUIDELINES.

In 1993, the Fifth Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC V) recommended diuretics and beta-blockers as first-line antihypertensive therapies because they are the only classes of drugs that had been shown to improve outcomes. What impact did these guidelines have? This analysis of data from about 35,000 retail pharmacies compared prescription volumes for various antihypertensive agents in 1992 and 1995.

Despite the JNC guidelines, use of calcium blockers and ACE inhibitors increased, while use of beta-blockers and diuretics decreased. For example, use of nifedipine, the number one drug in both years, increased 13 percent, while use of the number two drug in 1992, a diuretic, fell 59 percent. Overall, the "market share" for calcium blockers rose from 33 percent in 1992 to 38 percent in 1995, and ACE inhibitor use rose from 25 to 33 percent. In contrast, the market share of beta-blockers dropped from 18 to 11 percent, and that of diuretics dropped from 16 to 8 percent.

Comment: As the 1993 JNC recommendations for first-line therapy were recently reaffirmed by JNC VI (see the following story), these data must be discouraging for the developers and promoters of guidelines. They appear to confirm the effectiveness of pharmaceutical company marketing strategies.

— TH Lee

Published in Journal Watch General Medicine December 19, 1997

Citation(s):

Siegel D and Lopez J. Trends in antihypertensive drug use in the United States: Do the JNC V recommendations affect prescribing?. JAMA 1997 Dec 3 278 1745-1748.

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