BUSINESSWEEK ONLINE : OCTOBER 16, 2000 ISSUE
BUSINESSWEEK LIFESTYLE Are You Taking the Right Pill? Doctors often prescribe the costlier drugs Hypertension is epidemic in the U.S. Also known as high blood pressure, the disease afflicts more than 50 million Americans--one in every four adults. But only 25% of its victims have their blood pressure adequately controlled. This is a tragedy, because if left untreated, hypertension sharply increases the risk of heart disease and stroke--the first and third most common causes of death. It's not as though there aren't any treatment options. Over 100 drugs are available for the management of high blood pressure, and more await federal approval. Drugs aren't the only option, either. For many patients, diet and exercise can bring the condition under control. But the plethora of treatments can also be a curse. How is a person to choose? Don't assume you can leave everything in the hands of your doctor. The drugs recommended by federal guidelines as the first line of treatment are the least likely to be prescribed. Instead, doctors tend to prescribe far more costly, and more heavily promoted, medicines. But these are often no more effective--and are possibly more dangerous--than their cheaper alternatives. You might be better served modifying your diet and lifestyle, though few health plans will pay for a visit to a nutritionist. Hypertension, then, is a disease that cries out for an educated consumer. That education should start with a blood pressure test each year, especially if you are over 40. Don't put it off just because you're feeling fine. Hypertension has no symptoms. In fact, it's often called ''the silent killer,'' because if left unchecked, victims may not know they have it until they end up in the emergency room with a heart attack or stroke. RISK FACTORS. Blood pressure is the force of the blood against the walls of the arteries. The greater the pressure, the harder the heart has to work. Scientists aren't sure what causes the pressure to rise, but they have identified certain risk factors, including obesity, smoking, a high-salt diet, and a family history of hypertension. The disease also is more prevalent among men, the elderly, African-Americans, and residents of the Southeastern states. Blood pressure is written as a fraction, with a normal reading below 140/90, or 130/85 for high- risk patients such as diabetics. The first number represents systolic pressure, when the heart beats, while the second is diastolic pressure, when the heart relaxes between beats. Both numbers are important, but in May the National Heart, Lung & Blood Institute recommended that the systolic reading is more critical in older Americans. Researchers have discovered over the past decade that diastolic pressure rises until age 55 and then declines, while systolic blood pressure increases steadily with age. Clinical guidelines for the first-line treatment of hypertension recommend diuretics (i.e., water pills) and beta blockers--decades-old drugs that cost only about $3 a month. But be forewarned: Fewer than 1% of all U.S. hypertension prescriptions are for diuretics and beta-blockers, even though they are extremely effective and safe. Instead, almost 21% of hypertension prescriptions are for ACE (angiotensin-converting enzyme) inhibitors and 17% for calcium channel blockers, newer drugs that cost 10 to 15 times as much. Many medical experts are outraged by this prescribing pattern and blame it on a hard sell to doctors by profit-hungry drug companies. That's not always true: ACE inhibitors can be the best treatment for patients with complications, such as diabetes or heart disease. Calcium channel blockers are far more controversial. Several studies have found these drugs less effective than diuretics--and linked to serious side effects. ''There is no (hypertension) patient group that benefits from calcium channel blockers,'' insists Dr. Curt Furberg, professor of public health sciences at Wake Forest University School of Medicine. ''If a patient is prescribed these, he should talk to his doctor and ask why.'' In a recent analysis of 27,000 hypertension patients, Furberg found that taking calcium channel blockers instead of diuretics or beta blockers increased the risk of heart attack by 27% and of heart failure by 26%. Whatever drugs are prescribed, one of the greatest dangers for patients is complacency. ''This is a condition that must be managed for life,'' warns Dr. Sheldon Sheps, hypertension specialist at the Mayo Clinic. Patients with complications, such as hardening of the arteries, heart failure, or diabetes may have to take multiple drugs every day. Such a complicated treatment plan requires a high degree of teamwork between doctor and patient, an aspect of hypertension management that both often ignore. As a result, compliance is a major problem. ''Patients sometimes think they just need to take these drugs for a few weeks, like antibiotics,'' says Dr. David Brown, chief of clinical cardiology at Montefiore Medical Center in New York. Not true--if the medication is stopped, blood pressure shoots right back up, and the longer it goes untreated the more damage it causes. If the idea of taking a pill for the rest of your life depresses you, there might be another way. Patients with mild hypertension may be able to control their condition by exercising regularly and going on the DASH diet (for ''dietary approaches to stop hypertension''). Developed by the National Institutes of Health and proven to work in study after study, the DASH diet is rich in vegetables, fruit, and low-fat dairy foods. Granted, it's not easy to change your lifestyle, but doctors say patients who vigilantly follow DASH, lower their salt intake, and exercise a half-hour a day can dramatically lower their blood pressure. Start this program early enough and you may even be able to stop hypertension before it starts. ''My sense is that this is a totally preventable epidemic,'' says Dr. Lawrence Appel, associate professor of medicine at Johns Hopkins Medical School. And its never too late to begin a healthier regime, he notes--even elderly patients can lower their blood pressure with diet and exercise. So before you have to take a pill, take a walk. By CATHERINE ARNST _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ BACK TO TOP					RELATED ITEMS Are You Taking the Right Pill? 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