Evidenced-based prescription of blood pressure medications key to effectively preventing heart attacks and strokes
Heart attacks and strokes are the first and third leading cause of death in the elderly living in the United States. Traditionally, blood pressure medications have been the first and simplest method of combating these serious health events.
However, according to researchers at Saint Luke’s Mid America Heart Institute in Kansas City, many of the most commonly prescribed blood pressure medications have never been proven to reduce heart attacks, strokes or death and in some instances have actually produced evidence of harm.
In an article published in Postgraduate Medicine, Saint Luke’s Mid America Heart Institute leading cardiovascular research scientist James J. DiNicolantonio, Pharm.D., and cardiologist James H. O’Keefe, M.D., examined some of the most commonly prescribed blood pressure medications and their effectiveness in reducing heart attacks and mortality versus a placebo. In many instances, the research revealed that often the most popular medications are not only not the best, in many instances they are not any more effective than a placebo or may actually cause harm.
The most commonly prescribed thiazide diuretic in the United States is hydrochlorothiazide, with more than one million people receiving a prescription in 2008. However, this medication increased cardiovascular death and coronary heart disease compared to both the placebo and control in 2 clinical trials. Alternatively, only 25,000 people received a prescription for chlorthalidone in 2008, even though this medication consistently demonstrated significant reductions in heart attacks and strokes compared to placebo.
In addition, atenolol and metoprolol are the most widely prescribed beta blockers in the United States. However recent evidence and analysis shows atenolol significantly increases stroke, death and myocardial infarction when compared to other blood pressure medications. Lastly, the authors note the lack of evidence that angiotensin receptor blockers have for reducing heart attacks or death versus placebo.
“I think it is imperative we ask ourselves the question, why are these medications being prescribed and how do we change our method of selecting the best prescription for these patients,” said Dr. DiNicolantonio. “As clinicians, our goal is the optimal wellness of our patients, and in order to reduce heart attacks and deaths physicians need to prescribe medications which have proven to be effective.”
Currently there is no universal rating system in the United States where medications can be selected by clinicians based upon their effectiveness. Rather, insurance companies “pay for performance” or “pay for service” but this does not guarantee the selection of effective medications.
DiNicolantonio and O’Keefe recommend a two part solution to this problem:
- creation of an expert panel to rate medications based upon the amount of evidence for effectiveness of reducing cardiovascular events (either through trial comparison or systematic review and meta-analyses) and
- requiring insurance companies to preferentially pay for medications that have been shown to reduce cardiovascular events and improve survival.
“The appropriate prescription of evidence-based medications is the key to reducing the number of these very serious cardiovascular health events,” said DiNicolantanio. “Not only will the proper prescribing of these medications significantly reduce health care costs and save lives, it will lead to better and more effective health care in the future, which every patient deserves.”
Article DOI: 10.3810/pgm.2014.11.2846. For more information about the authors, visit http://www.saintlukeshealthsystem.org/dinicolantonio.
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