Is it the same thing?

31 Jan 2004 05:11:54 -0800 in article
<[email hidden]> [email hidden]

(francispoon) said:

My ENT doctor told me that a bp of 130/80 achievable through using diurectics is less preferred to
one achieved through a blood dilator such as calcium channel blocker for the simple reason that the
former is achieved using 'thick' blood while the latter thinner blood.

If blood "thickness", i.e. risk of thromboembolism is a problem, take about 100 mg aspirin daily.
Read also the following clippings (or the whole articles if you have time):

Ubel PA, Jepson C, Asch DA. Misperceptions About beta-Blockers and Diuretics. J Gen Intern Med. 2003
Dec;18(12):977-83. PMID: 14687255 [PubMed - in process] <URL:http://www.ncbi.nlm.nih.gov/entrez/que-
ry.fcgi?cmd=Retrieve&db=PubMed&list_uids=14687255&dopt=Abstract>

"... CONCLUSIONS: Despite numerous clinical trials showing no difference in the effectiveness or
side-effect profiles of these 4 classes of drugs, most physicians believed that diuretics were
less effective and beta-blockers were less tolerated than other medications. Moreover, their
prescription practices were associated with their provision of free samples provided by
pharmaceutical representatives, even after adjusting for other demographic characteristics.
Efforts to increase physicians' prescribing of beta-blockers and diuretics may need to be
directed at overcoming misunderstandings about the effectiveness and tolerability of these
medicines."

Doctors More Likely to Prescribe Pricey New Blood Pressure Drugs Despite Standards
<URL:http://www.newswise.com/articles/view/502414/>

"Even though research has shown inexpensive treatments for high blood pressure are just as
effective as pricey new drugs, doctors perceive the new drugs as more effective and think they
carry fewer side effects, according to a new study by a University of Michigan Health System
physician.

[...]

“These new, more expensive medications are being more heavily promoted by the drug companies,
and one way or another that information influences how people perceive the drug’s
effectiveness,” says study author Peter A. Ubel, M.D., associate professor of internal medicine
at the U-M Medical School and director of the U-M Health System’s Program for Improving Health
Care Decisions.

[...]

“The industry influence is pervasive,” says Ubel, who is also a research investigator at the
Ann Arbor Veterans Administration Health Center. “I think a lot of physicians do rely on sales
representatives to tell them about the latest medications out there. How else do you find this
out? It is very hard to keep up on the medical literature. Doctors feel it’s an educational
visit, but the sales reps hand out samples.”"

This matter doesn't seem to have changed much in five years. In September 1998 The Lancet
published the study

Malcolm Maclure, Colin Dormuth, Terryn Naumann, James McCormack, Robert Rangno, Carl Whiteside,
James M Wright. Influences of educational interventions and adverse news about calcium-channel
blockers on first-line prescribing of antihypertensive drugs to elderly people in British Columbia.
The Lancet Volume 352, Number 9132, 19 September 1998, pp. 943-948.
<URL:http://www.thelancet.com/journal/vol352/iss9132/full/llan.352.9132.original_research.6005.1>

from which one can conclude that new widely reported scientific observations only very slowly affect
the doctor's prescribing behavior. The above study has been commented in the article

Prescribing habits often slow to change
dailynews.yahoo.comstory.htmlOpen ↗
thriveonline.com740.htmlOpen ↗

The links are now obsolete, but I happen to have saved the following citation:

"Many Canadian doctors continued to prescribe certain drugs for patients with high blood
pressure even after an avalanche of media coverage on the possible health risks of these drugs,
and against recommendations published in professional guidelines, according to a new study.

The study findings ``are consistent with other research showing that physicians are cautious
about changing their prescribing practices,'' the research team writes this week in The Lancet.

Dr. James Wright of the University of British Columbia in Vancouver and colleagues looked at
over 4,400 physicians in British Columbia who prescribed a diuretic, a beta-blocker, an angiotensin-
converting enzyme (ACE) inhibitor drug or a calcium channel blocker for the first time for a
total of 36,507 hypertensive patients between 1993 and 1996.

The researchers report that about 22% of these patients were prescribed calcium channel blockers
as first-line therapy in 1994 although professional guidelines suggested that beta blockers or
diuretics were more appropriate as a first choice.

And prescribing practices did not change in early 1995 after a study reported that patients
taking some calcium channel blockers might be at higher risk of heart attack than those taking
other drugs.

But the team did find that small shifts in prescribing in July 1995 and in early 1996, after the
release of more reports on the risks of these drugs in some patients.

``Our main finding was that, despite many news reports, a warning letter and two issues of a
regular newsletter, physicians continued to prescribe... (calcium channel blockers) as first-
line therapy to at least 33% of patients, contrary to guidelines,'' the authors write.

``We conclude that, for new evidence to have an immediate impact on prescribing, innovative
forms of continuing medical education and new ways of warning physicians must be developed
and evaluated,'' they conclude. ``In the meantime, prescribing can be expected to improve
only gradually in response to multiple messages delivered by multiple methods, including the
lay media.''

SOURCE: The Lancet 1998;352:943-948."

More about this topic in the abstract of the study

Manolio TA, Cutler JA, Furberg CD, Psaty BM, Whelton PK, Applegate WB. Trends in pharmacologic
management of hypertension in the United States. Arch Intern Med. 1995 Apr 24;155(8):829-37.
Review. <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=771779-
1&dopt=Abstract>

A citation:

"CONCLUSIONS: Use of calcium antagonists and angiotensin-converting enzyme inhibitors in
hypertension has increased dramatically in the past 10 years. Without convincing evidence of the
advantages of these agents, it is difficult to explain the continued decline in the use of less
expensive agents, such as diuretics and beta-blockers, which are the only antihypertensive agents
proved to reduce stroke and coronary disease in hypertensive patients."

Comments in the articles

Study: Calcium Antagonists and ACE Inhibitors Overused in Hypertension
pharminfo.comccbace ovr.htmlOpen ↗ (link no longer worksi)

"Manolio et al. explored possible reasons for the shift to newer types of drugs. These included
improved efficacy in preventing cardiovascular morbidity and mortality, rising incidence of
concomitant illnesses necessitating the use of newer drugs, improved blood- pressure-lowering
effects, improved side effect profiles, lower cost, and increased marketing pressure and
attractiveness of newer drugs.

The investigation showed that changes in drug use could not be explained by any of the first
five reasons."

[...]

"The investigators concluded, "Although there may be legitimate reasons, such as coexisting
angina or congestive failure, to choose newer agents in selected patients, this does not appear
to justify their use as routine therapy in uncomplicated hypertension. No data are currently
available to demonstrate the superiority of calcium antagonists and ACE inhibitors in reducing
cardiovascular morbidity and mortality from hypertension, but there is ample evidence of their
greater cost. While health costs are under sharp attack, it seems irrational to divert
substantial resources by substituting unproven and more expensive remedies for tried and tested
drugs. Since the vast majority of hypertensive patients can be treated with relatively
inexpensive, proved agents, the trend toward increased use of costly, unproved agents in routine
management of hypertension requires careful reconsideration." "

and

Doctors Not Prescribing Recommended Drugs to Treat Hypertension
heartinfo.comhbpdrg12497.htmOpen ↗ (link no longer works)

"There are enormous cost implications of prescribing calcium channel blockers instead of
diuretics, according to the study. Since calcium channel blockers cost close to 60 times the
price of diuretics, prescribing diuretics could save hundreds of millions of dollars. Possible
reasons for doctors' prescribing habits mentioned by the authors are that not enough doctors
were informed of the treatment guidelines, and that physicians may have been influenced by drug
company advertising."

--
Matti Narkia

francispoon said:

My ENT doctor told me that a bp of 130/80 achievable through using diurectics is less preferred to
one achieved through a blood dilator such as calcium channel blocker for the simple reason that
the former is achieved using 'thick' blood while the latter thinner blood.

Any comment?

Your Ear, Nose, Throat specialist does not appear to be a Hypertension specialist.

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

--
Who is the humblest person in the universe?

makeashorterlink.commakeashorterlink.comOpen ↗

I don't think so. A huge study showed that diurectics were safe and effective. They are also far
cheaper. However, the best (no side effects) way to lower BP is the "Dash" diet developed by the
NIH. See www.nhlbi.nih.gov/health/public/ heart/hbp/dash/new_dash.pdf Finally, your goal should be
120/80 not 130/80.

[email hidden] (francispoon) wrote in message
news:<[email hidden]>...

Quoted message said:

My ENT doctor told me that a bp of 130/80 achievable through using diurectics is less preferred to
one achieved through a blood dilator such as calcium channel blocker for the simple reason that
the former is achieved using 'thick' blood while the latter thinner blood.

Any comment?

FP

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

francispoon said:

My ENT doctor told me that a bp of 130/80 achievable through using diurectics is less preferred
to one achieved through a blood dilator such as calcium channel blocker for the simple reason
that the former is achieved using 'thick' blood while the latter thinner blood.

Any comment?

Your Ear, Nose, Throat specialist does not appear to be a Hypertension specialist.

He said blood flows more easily when it is thin and he believes my tinnitus has something to do with
my vasecular conditions. Also, he is suspecting the continuous deposit on blood vessels of
additional potassim from Dyazide and its effects. He advised me to switch from diurectics to Plendil
for the reason that Plendil as a dilator could help 'treat my migraine or a headache and a ring on
the left side of my brain. I wonder if Zestril or ACE inhibitor has the same property for that. That
*seems* to work, but i am not quite sure if it is a correlational or causal relationship. Plendil is
OK except that it has to be administered with beta-blocker which produces impotence. Also, when i
was using diurectics, i found it hard to have a nap without subsequent repercussion of more rings
from my tinnitus. Without plendil, it is OK. I am still experimenting as a desperate person who
tries to treat the tinnitus.

By the way, if I were not satisfied with the current combination, could I go back or would the old
medicine lose their effectiveness once I check out?

Comments, please.

FP
=============================================

Quoted message said:

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD Board-Certified Cardiologist heartmdphd.comheartmdphd.comOpen ↗

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

francispoon said:

My ENT doctor told me that a bp of 130/80 achievable through using diurectics is less preferred
to one achieved through a blood dilator such as calcium channel blocker for the simple reason
that the former is achieved using 'thick' blood while the latter thinner blood.

Any comment?

Your Ear, Nose, Throat specialist does not appear to be a Hypertension specialist.

I am using 10mg of Zestril, 2.5 mg of Plendil and 25 mg of beta-lock soc. Do you think I should move
out of Zestril and concentrate on (increase) Plendil and beta-blocker in order to acheive better
effect? I find this combination to complicated. In the long run, I think the combination of Plendil
and beta-blocker would be optimal. Principally, is that correct?

THX

FP

Quoted message said:

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD Board-Certified Cardiologist heartmdphd.comheartmdphd.comOpen ↗

Matti Narkia <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

31 Jan 2004 05:11:54 -0800 in article <[email hidden]>

(francispoon) said:

My ENT doctor told me that a bp of 130/80 achievable through using diurectics is less preferred
to one achieved through a blood dilator such as calcium channel blocker for the simple reason
that the former is achieved using 'thick' blood while the latter thinner blood.

If blood "thickness", i.e. risk of thromboembolism is a problem,

My ENT specialist relates this problem to my poor blood circulation which he believes has given rise
to my tinnitus. As a matter of fact, ALL the doctors i have seen point to poor blood circulation as
the culprit of my tinnitus. Strangely, none of the participating doctors or experts in ALT is
willing to look into that direction.

take about

Quoted message said:

100 mg aspirin daily. Read also the following clippings (or the whole articles if you have time):

Ubel PA, Jepson C, Asch DA. Misperceptions About beta-Blockers and Diuretics. J Gen Intern Med.
2003 Dec;18(12):977-83. PMID: 14687255 [PubMed - in process] <URL:http://www.ncbi.nlm.nih.gov/ent-
rez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14687255&dopt=Abstract>

"... CONCLUSIONS: Despite numerous clinical trials showing no difference in the effectiveness
or side-effect profiles of these 4 classes of drugs,

I disagree. I like diurectics because it solves my constipation

THAT IS EMPIRICAL TO *ME*. The test of the pudding is in the eating, not in some graduate papers
writen by professionals who are running out of topics for their ph.d dissertations.

FP
===========================================================

most physicians believed that diuretics were less

Quoted message said:

effective and beta-blockers were less tolerated than other medications. Moreover, their
prescription practices were associated with their provision of free samples provided by
pharmaceutical representatives, even after adjusting for other demographic characteristics.
Efforts to increase physicians' prescribing of beta-blockers and diuretics may need to be
directed at overcoming misunderstandings about the effectiveness and tolerability of these
medicines."

Doctors More Likely to Prescribe Pricey New Blood Pressure Drugs Despite Standards
<URL:http://www.newswise.com/articles/view/502414/>

"Even though research has shown inexpensive treatments for high blood pressure are just as
effective as pricey new drugs, doctors perceive the new drugs as more effective and think they
carry fewer side effects, according to a new study by a University of Michigan Health System
physician.

[...]

?These new, more expensive medications are being more heavily promoted by the drug companies,
and one way or another that information influences how people perceive the drug?s
effectiveness,? says study author Peter A. Ubel, M.D., associate professor of internal
medicine at the U-M Medical School and director of the U-M Health System?s Program for
Improving Health Care Decisions.

[...]

?The industry influence is pervasive,? says Ubel, who is also a research investigator at the
Ann Arbor Veterans Administration Health Center. ?I think a lot of physicians do rely on
sales representatives to tell them about the latest medications out there. How else do you
find this out? It is very hard to keep up on the medical literature. Doctors feel it?s an
educational visit, but the sales reps hand out samples.?"

This matter doesn't seem to have changed much in five years. In September 1998 The Lancet
published the study

Malcolm Maclure, Colin Dormuth, Terryn Naumann, James McCormack, Robert Rangno, Carl Whiteside,
James M Wright. Influences of educational interventions and adverse news about calcium-channel
blockers on first-line prescribing of antihypertensive drugs to elderly people in British
Columbia. The Lancet Volume 352, Number 9132, 19 September 1998, pp. 943-948.
<URL:http://www.thelancet.com/journal/vol352/iss9132/full/llan.352.9132.original_research.6005.1>

from which one can conclude that new widely reported scientific observations only very slowly
affect the doctor's prescribing behavior. The above study has been commented in the article

Prescribing habits often slow to change
dailynews.yahoo.comstory.htmlOpen ↗
thriveonline.com740.htmlOpen ↗

The links are now obsolete, but I happen to have saved the following citation:

"Many Canadian doctors continued to prescribe certain drugs for patients with high blood
pressure even after an avalanche of media coverage on the possible health risks of these
drugs, and against recommendations published in professional guidelines, according to a new
study.

The study findings ``are consistent with other research showing that physicians are cautious
about changing their prescribing practices,'' the research team writes this week in The
Lancet.

Dr. James Wright of the University of British Columbia in Vancouver and colleagues looked at
over 4,400 physicians in British Columbia who prescribed a diuretic, a beta-blocker, an
angiotensin-converting enzyme (ACE) inhibitor drug or a calcium channel blocker for the
first time for a total of 36,507 hypertensive patients between 1993 and 1996.

The researchers report that about 22% of these patients were prescribed calcium channel
blockers as first-line therapy in 1994 although professional guidelines suggested that beta
blockers or diuretics were more appropriate as a first choice.

And prescribing practices did not change in early 1995 after a study reported that patients
taking some calcium channel blockers might be at higher risk of heart attack than those taking
other drugs.

But the team did find that small shifts in prescribing in July 1995 and in early 1996, after
the release of more reports on the risks of these drugs in some patients.

``Our main finding was that, despite many news reports, a warning letter and two issues of a
regular newsletter, physicians continued to prescribe... (calcium channel blockers) as first-
line therapy to at least 33% of patients, contrary to guidelines,'' the authors write.

``We conclude that, for new evidence to have an immediate impact on prescribing, innovative
forms of continuing medical education and new ways of warning physicians must be developed and
evaluated,'' they conclude. ``In the meantime, prescribing can be expected to improve only
gradually in response to multiple messages delivered by multiple methods, including the lay
media.''

SOURCE: The Lancet 1998;352:943-948."

More about this topic in the abstract of the study

Manolio TA, Cutler JA, Furberg CD, Psaty BM, Whelton PK, Applegate WB. Trends in pharmacologic
management of hypertension in the United States. Arch Intern Med. 1995 Apr 24;155(8):829-37.
Review. <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=77177-
91&dopt=Abstract>

A citation:

"CONCLUSIONS: Use of calcium antagonists and angiotensin-converting enzyme inhibitors in
hypertension has increased dramatically in the past 10 years. Without convincing evidence of the
advantages of these agents, it is difficult to explain the continued decline in the use of less
expensive agents, such as diuretics and beta-blockers, which are the only antihypertensive
agents proved to reduce stroke and coronary disease in hypertensive patients."

Comments in the articles

Study: Calcium Antagonists and ACE Inhibitors Overused in Hypertension
pharminfo.comccbace ovr.htmlOpen ↗ (link no longer worksi)

"Manolio et al. explored possible reasons for the shift to newer types of drugs. These
included improved efficacy in preventing cardiovascular morbidity and mortality, rising
incidence of concomitant illnesses necessitating the use of newer drugs, improved blood- pressure-
lowering effects, improved side effect profiles, lower cost, and increased marketing pressure
and attractiveness of newer drugs.

The investigation showed that changes in drug use could not be explained by any of the first
five reasons."

[...]

"The investigators concluded, "Although there may be legitimate reasons, such as coexisting
angina or congestive failure, to choose newer agents in selected patients, this does not appear
to justify their use as routine therapy in uncomplicated hypertension. No data are currently
available to demonstrate the superiority of calcium antagonists and ACE inhibitors in reducing
cardiovascular morbidity and mortality from hypertension, but there is ample evidence of their
greater cost. While health costs are under sharp attack, it seems irrational to divert
substantial resources by substituting unproven and more expensive remedies for tried and tested
drugs. Since the vast majority of hypertensive patients can be treated with relatively
inexpensive, proved agents, the trend toward increased use of costly, unproved agents in
routine management of hypertension requires careful reconsideration." "

and

Doctors Not Prescribing Recommended Drugs to Treat Hypertension
heartinfo.comhbpdrg12497.htmOpen ↗ (link no longer works)

"There are enormous cost implications of prescribing calcium channel blockers instead of
diuretics, according to the study. Since calcium channel blockers cost close to 60 times the
price of diuretics, prescribing diuretics could save hundreds of millions of dollars. Possible
reasons for doctors' prescribing habits mentioned by the authors are that not enough doctors
were informed of the treatment guidelines, and that physicians may have been influenced by
drug company advertising."

francispoon said:

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message
news:<[email hidden]>...

Quoted message said:

francispoon said:

My ENT doctor told me that a bp of 130/80 achievable through using diurectics is less
preferred to one achieved through a blood dilator such as calcium channel blocker for the
simple reason that the former is achieved using 'thick' blood while the latter thinner blood.

Any comment?

Your Ear, Nose, Throat specialist does not appear to be a Hypertension specialist.

He said blood flows more easily when it is thin and he believes my tinnitus has something to do
with my vasecular conditions. Also, he is suspecting the continuous deposit on blood vessels of
additional potassim from Dyazide and its effects. He advised me to switch from diurectics to
Plendil for the reason that Plendil as a dilator could help 'treat my migraine or a headache and a
ring on the left side of my brain. I wonder if Zestril or ACE inhibitor has the same property for
that. That *seems* to work, but i am not quite sure if it is a correlational or causal
relationship. Plendil is OK except that it has to be administered with beta-blocker which produces
impotence. Also, when i was using diurectics, i found it hard to have a nap without subsequent
repercussion of more rings from my tinnitus. Without plendil, it is OK. I am still experimenting
as a desperate person who tries to treat the tinnitus.

By the way, if I were not satisfied with the current combination, could I go back or would the old
medicine lose their effectiveness once I check out?

You should be able to go back.

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

--
Who is the humblest person in the universe?

makeashorterlink.commakeashorterlink.comOpen ↗

francispoon said:

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message
news:<[email hidden]>...

Quoted message said:

francispoon said:

My ENT doctor told me that a bp of 130/80 achievable through using diurectics is less
preferred to one achieved through a blood dilator such as calcium channel blocker for the
simple reason that the former is achieved using 'thick' blood while the latter thinner blood.

Any comment?

Your Ear, Nose, Throat specialist does not appear to be a Hypertension specialist.

I am using 10mg of Zestril, 2.5 mg of Plendil and 25 mg of beta-lock soc. Do you think I should
move out of Zestril and concentrate on (increase) Plendil and beta-blocker in order to acheive
better effect? I find this combination to complicated. In the long run, I think the combination of
Plendil and beta-blocker would be optimal. Principally, is that correct?

That would have to be empirically determined.

Quoted message said:

THX

You are welcome, Francis :-)

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

--
Who is the humblest person in the universe?

makeashorterlink.commakeashorterlink.comOpen ↗