1 / 19

Pre-ALLHAT Drug Use

Pre-ALLHAT Drug Use. 60. CCBs. Beta Blockers. Diuretics. Diuretics. 50. ACE Inhibitors. 40. ß-Blockers. % of Treated Patients on Medication. 30. 20. ACE Inhibitors. 10. CCBs. 0. 1978. 1980. 1982. 1984. 1986. 1988. 1990. 1992. Year. IMS Health NDTI, 1978-1992. ALLHAT.

jena-benton
Télécharger la présentation

Pre-ALLHAT Drug Use

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pre-ALLHAT Drug Use 60 CCBs Beta Blockers Diuretics Diuretics 50 ACE Inhibitors 40 ß-Blockers % of Treated Patients on Medication 30 20 ACE Inhibitors 10 CCBs 0 1978 1980 1982 1984 1986 1988 1990 1992 Year IMS Health NDTI, 1978-1992

  2. ALLHAT Background • In addition to their BP lowering potential all antihypertensive agents have other important mechanisms of action, indications, and side effects. • These actions may convey benefits or risks independent of BP lowering • By having a common BP goal for all treatment arms, ALLHAT aimed to evaluate the health effects of these non-BP actions

  3. ALLHAT Overall Purpose To determine whether the newer, more costly antihypertensive drugs - CCBs, ACE inhibitors and alpha-blockers - are superior to the older, less expensive diuretics in preventing CV complications of hypertension.

  4. ALLHAT Health Effects of Diuretics Low-dose thiazide-type diuretic-based treatment in large clinical trials has been shown to reduce the risks of: Event reduction % Stroke 34 Heart failure 42 CHD 28 CVD mortality 24 Total mortality 10 Psaty et al., JAMA 1997;277:739-45

  5. ALLHAT Strengths • Largest hypertension trial ever (n=42,418); practice-based • Diverse study population • High methodologic standards • Independent sponsorship and conduct • Conclusions based on 10,834 cardiovascular events

  6. ALLHAT Implications • Selection of first-line drug • Selecting treatments for particular patients • Drug cost and health benefit ● To patients ● To society 4. Design of future hypertension trials 5. Impact on treatment guidelines

  7. ALLHAT Implications Selection of 1st-line Drug - Conclusions Among antihypertensive drugs, thiazide-like diuretics were unsurpassed in: • long-term drug adherence • controlling elevated blood pressure and were superior to other therapies in • preventing one or more forms of cardiovascular events • having lower drug cost

  8. ALLHAT Implications Selection of 2nd-line Drug(s) - Type of Add-on • Large proportion of hypertensive patients require additional drug(s) for BP control • No direct comparison of 2nd-line drugs in ALLHAT • Optimal type of add-on agent unknown • Need for large trials comparing different classes of agents added to diuretics

  9. 2002 Use of Antihypertensive Medications, Proportion of Drug-Treated Patients by Drug Class 40% 37% 30% 27% 20% 20% 19% % Patients 20% 10% 0% ACE- Calcium Diuretics Beta- ARBs Inhibitors Channel Blockers Blockers Source: NDTI -- IMS HEALTH

  10. ALLHAT Implications Selecting Treatments for Particular Patients I Benefits of diuretics generalizable to: • Men and women • Age group <65 and > 65 yrs • Blacks and non-blacks • Diabetics and non-diabetics • Presence and absence of other co-morbidity

  11. ALLHAT Implications Selecting Treatments for Particular Patients II Diuretics are better than: • ACEIs (lisinopril) for patients at high risk of CVD events, especially heart failure, as well as for African-Americans at risk of stroke • Alpha-blockers (doxazosin) for patients at high risk of heart failure, stroke, angina and coronary revascularizations • CCBs (amlodipine) for patients at high risk of developing heart failure

  12. ALLHAT Implications Selecting Treatments for Patients - Conclusions Thiazide-type diuretics should be considered for nearly all patients with hypertension: • Untreated patients • Inadequately controlled patients on non-diuretic agent(s) • Controlled patients on non-diuretic agent(s) unless compelling indication exists for another agent

  13. ALLHAT Implications Drug Cost to Patient (U.S. 2002) Annual Chlorthalidone $ 36 Amlodipine $679 Lisinopril - branded $533 - generic** $280 *Drugstore.com (exclusive of dispensing fee) **available 3rd quarter 2002

  14. ALLHAT Implications Drug Cost to Society Average Annual Drug Cost/Pt* Total Drug Cost** No. of Annual Users** ACEIs $280- 12.7 $3,556- 533 6,769 CCBs $679 9.3 $6,315 Diuretics $ 36 6.9 $ 248 *price of largest selling drug/class (2002) **in million

  15. ALLHAT Implications Excess CV Events 6-yr Excess Total Users* Excess events/yr** ACEIs Comb CV 2.3% 12.7 48,700 Events CCBs CHF 2.5% 9.3 38,800 *in million **concomitant use of diuretics may reduce these numbers by up to 20%

  16. ALLHAT Implications Design of Hypertension Trials Thiazide-like diuretics, in low to moderate dose, should be the treatment control group of future comparative trials in patients with hypertension.

  17. ALLHAT Implications Treatment Guidelines Thiazide-like diuretics, in low to moderate dose, should be the guideline-recommended first-line drug treatment for nearly all patients with hypertension.

  18. ALLHAT Implications Conclusions I • The benefit of diuretics as first-line therapy applies to nearly all patients with hypertension • Diuretics are superior or unsurpassed in reducing the risks of cardiovascular complications • Diuretics are the least expensive agents for treating hypertension

  19. ALLHAT Implications Conclusions II • Translating the ALLHAT findings into practice will reduce the financial cost of antihypertensive drugs and reduce the societal burden of CV complications • Future comparative hypertension trials should use diuretics as the control group or base therapy • Treatment guidelines are being revised to reflect the ALLHAT findings

More Related