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Don't criticise GPs for sticking to older hypertension drugs

Re-your article 'GPs stick to older hypertension drugs' (September 8): the World Heart Federation, rather than criticising UK GPs for prescribing 'older' drugs for hypertension when compared with their European counterparts, I think they should be congratulated.

Evidence to support this view comes from a recent meta-analysis (JAMA 2003; 289:2534-44) which reviewed 42 clinical trials, including ALLHAT and the just-released Australian National Blood Pressure Study, involving 192,478 patients randomised to seven major treatment strategies, including placebo.

Low-dose diuretics ­ which are cheap and do not have an army of drug representatives trying to break down the surgery door ­ were clearly shown to be the best first-line therapy for almost all patients, including those with diabetes and asymptomatic LVH.

Interestingly, blood pressure changes were similar with all the different medications reviewed, which questions the value of 'equivalent lowering of blood pressure' as a surrogate marker in this condtion. Furthermore, in the largest trial, ALLHAT, low-dose diuretics were also shown to have the lowest rate of drop-outs due to intolerance.

Regarding the LIFE study, the study group showing benefit with losartan represent a select group of patients with hypertension. Perhaps, more importantly, the trial does not prove superiority over thiazides.

I do, however, wholly endorse the final quote from Dr Pittard that '....we implement the most current clinical evidence....'.

Scott Pegler

Clinical and Information Pharmacist

Swansea

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