Profit for Big Pharma – 3: over-prescribing questioned

24 Aug

After having a routine tetanus jab the writer was asked to have a blood pressure check and went online to refresh the memory about levels and significance.

The next day this headline was seen on the BBC website: Over-diagnosis: High Blood Pressure. The Inside Health programme may be heard via the ‘Listen Again” link – and one transcript extract follows.

White coat hypertension

“If you look at a diagnosis of high blood pressure based on what we do at the moment in the doctor’s office measurement we think about a quarter of people who have their blood pressure measured in the doctor’s office and it’s elevated and they’re labelled as hypertensive, if they measure it away from the doctor’s office it’s actually normal and that’s what we’ve been in the past calling white coat hypertension even though we don’t wear white coats anymore.” 

Treating patients with stage 1 (mild) hypertension is not beneficial

Reference to a review, prompted a search which revealed on the BMJ website: ‘Cochrane review finds no proved benefit in drug treatment for patients with mild hypertension’, BMJ 2012; 345 doi: 10.1136/bmj.e5511 (Published 15 August 2012)

The Cochrane review of studies conducted in the United States, Australia and the United Kingdom has found that drug treatment did not reduce total mortality, coronary heart disease, or stroke. Health Matters reports that David Cunliffe, one of the reviewers, said that he believes the analysis should lead to dramatic changes in the way doctors treat mild hypertension, allowing patients with hypertension to throw away their blood pressure pills and focus instead on far more effective as well as evidence based approaches, such as exercising, smoking cessation, and eating a DASH (diet against systolic hypertension) or Mediterranean diet.

Blood pressure pills?

On the NHS list:

   Diuretics (“water pills”)
  Beta-blockers
  Calcium Channel Blockers
  Angiotensin Converting Enzyme Inhibitors
  Angiotensin II Receptor Blockers
  Less common and combination drugs.
 

Speaking on behalf of the Blood Pressure Association, Professor Gareth Beevers issued the following comment:

“The findings of this Cochrane review are that there is no medium-term benefit (5 years) from treating mild hypertension (140-159/90-99) in patients with no evidence of cardiovascular end-organ damage.

“This is in keeping with the 2011 NICE guidelines which recommend the threshold 160/100 for starting treatment in patients with no CVD (cardiovascular disease) or diabetes.”

Many people have been given unnecessary medication and in some instances reported this has had undesirable side effects. But how financially profitable it has been for manufacturers!

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