TREATING HYPERTENSION RATIONALLY:
30 Jan 30 1998 at 20:06, Toby Lipman wrote:
> The thing which bothers me about ACE IIs (and ACE Is,
> comen to mention it) it the way they are labelled "antihypertensives" -
> and have without exception been so licenced and marketed in the UK
> before being licenced for the treatment of heart failure.
> Why do we treat hypertension in the first place?
Reduce number of strokes and possibly MIs. Prevent heart failure and
maybe renal insufficiency.
> What is the NNT for preventing CVD events in patients with uncomplicated
> hypertension? (OK it varies with age)
High. Lower in elderly with hypertension.
> How much do ACE inhibitors cost?
Too much to be used as initial drugs for uncomplicated hypertension
> Are they more effective in preventing CVD than beta blockers or
> thiazides?
Probably not. Noone knows as there are no studies showing ACE-Is
effect on hard endpoints as strokes and MIs.
> Is there *any* justification for prescribing ACE IIs (or Is) for
> hypertension apart from in some diabetics or patients with co-existing
> heart failure?
Yes! Peaple with severe asthma allergic to thiazides and calcium
antagonists!
> What is the point of licencing a drug (whose greatest benefit is likely
> to be in the treatment of heart failure) for hypertension only when
> there is likely to be no benefit compared to drugs which are a hundred
> times cheaper?
Profit of course
Yes, I understant the questions were purely rethoric. Sorry just
could not resist answering.....
Anders /Sweden
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Anders Hernborg M.D. (Gen pract.)
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