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Tacit King of the Hill

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Cardiovascular disease, I surmise, is very concerning, and is likely a cause of distress for many who seek the best treatment once the disease presents itself. As a result, there are many treatment options available to delay if not prevent such diseases, yet many health care providers are understandably unclear as to which option is the most effective with these deadly disease states manifested by substandard cardiovascular function.

Potential reassurance was made available with the results of the ALLHAT trial, which was conceptualized and implemented by the National Institute of Health, and was published over five years ago. This trial was the largest study addressing, among other variables, those with hypertension. In addition, the ALLHAT trial included over 40,000 subjects over the age of 55. While Pfizer financially contributed a small portion to support this trial, ALLHAT was conceptualized and implemented by the National Institutes of Health at a cost of around 130 million dollars.

ALLHAT trial, as a result, was largely if not completely void of bias and commercial interference. Because of the ideal way in which this trial was conducted and completed, most concur the results of this trial are quite accurate and valid. ALLHAT actualized a bonafide comparative analysis of various classes of those drugs for hypertension, which included calcium channel blockers, ACE inhibitors, Alpha Blockers, and Beta Blockers, and diuretics as the researchers examined the action of these classes of medications on the subjects who possessed cardiovascular disease, all of who were over the age of 55 and numbered well over 40,000 people in the ALLHAT trial. As the trial was completed with data collected over a 4 year period, the trial concluded that one particular class of medications included in this study proved to be the most advantageous for the subjects, and this class of drugs are as old as the subjects in the study.

ALLHAT results specifically and clearly concluded that thiazide diuretics are, overall, the preferred choice of initial medicinal therapy absent of compelling concominant indications or additional disease states.

This class of medication has been available in the United States for well over 50 years, and presently costs about 25 dollars a year, instead of a few dollars a day for many if not most branded medications for CV conditions. So this finding, of course, is far less expensive than the other classes of medications that were involved in the ALLHAT trial that will be discussed in this article that diuretics were compared to, as they relate to their effects on such cardiovascular disease states as hypertension, decreased risk of myocardial infarctions, incidences of stroke, as well as the development of heart failure.

The ALLHAT study was the largest study ever performed utilizing the comparative effectiveness protocol. To reiterate, the medications included in this trial that compared various classes of medications for the cardiovascular benefits they may provide included calcium channel blockers, ACE inhibitors, and Alpha Blockers, beta blockers, and, thankfully, thiazide diuretics.


The ALLHAT trial proved that thiazide diuretics are superior to the other classes of medications when compared with them in this trial in relation to the ability to reduce hypertension as well as decreasing the risk of myocardial infarctions in the patients studied in this trial as well. Furthermore, diuretics were superior in comparison with calcium channel blockers as well as the beta blocker as related to additional cardiovascular disease states such as strokes and heart failure. Also, the ALLHAT study was unique as it was addressing the comparative effectiveness of all drugs mentioned, instead of simply comparing one class of a drug to simply a placebo for these cardiovascular disease states, as the latter protocol is performed rather often.

Of no great surprise, the results of the ALLHAT study appeared to be of notable concern to those who historically have profited greatly off of those other classes of expensive and branded drugs that failed to demonstrate any advantage over the diuretic in this study- which again showed diuretics to be the one class of medications that proved to be most advantageous of all the classes of drugs examined in this study related to the cardiovascular issues addressed in this study. The branded medications in the inferior classes of drugs cost dollars a day, instead of the pennies a day that diuretics cost. The efficacy and cost advantages of diuretics are no longer speculative. They were proven to be the preferred choice for medicinal therapy related to the diseases mentioned.

The significance of the ALLHAT study related to the advantages and benefits regarding the utilization of diuretics, unfortunately was not recognized or acknowledged within the medical community, others have said based on reviews of prescribing habits following this trial. The reasonable and necessary selection of a diuretic as a preferred choice of medicinal treatment for appropriate patients proven with the ALLHAT trial somehow tacitly atrophied rapidly after the results of the ALLHAT trial were released, which prevented the need for these results to be actualized by health care providers, overall. Many reasons why this did not occur have been suggested:

For example, drugs combining two medications from different classes of medications for hypertension are preferred by many health care providers for understandable reasons presently- depending on the severity of the cardiovascular disease states that may exist, along with the risk of developing these cardiovascular conditions. It is not unusual, for example, for a branded pharmaceutical company to combine their medication for hypertension with a diuretic for those patients that may have a stage of hypertension that requires simply more than just one drug for reduction of their high blood pressure.

Also, those companies promoting those classes of medications addressed in the ALLHAT study that proved to be inferior compared with the class of diuretics aggressively continued to promote their medications most likely for profit reasons, and appeared to do so in a rather vexing and corruptive manner after the ALLHAT results were available. Demonstrations of the promotional activities by these companies included thorough saturation of drug samples to health care providers of their inferior medications that belonged to the classes of drugs illustrated in the ALLHAT trial, as well as the companies who produced these products investing large amounts of promotional spending in a variety of ways to blunt or disregard the beneficial effects of the thiazide diuretic that should have been recognized by more health care providers than it was, as others have stated. The concept of what truly would be the most reasonable and necessary treatment option for cardiovascular patients was clearly not an objective for these promoters of more expensive, yet less effective medications. So much for the image of branded pharmaceutical companies striving for the optimal health of others, huh?

I'm comfortable as a layperson in suggesting that the cardiovascular experts should and are obligated to make others aware of the results of the ALLHAT trial, and convince others who would concur that diuretics should be the preferred choice of medicinal therapy for the medical conditions illustrated when they happen to exist in such patients, of which there are many. This would ensure that these patients would receive the proven and ideal treatment to delay the progression, if not the prevention, of these cardiovascular events addressed in the ALLHAT trial, and billions of dollars each year would be saved. Unfortunately, it appears what may be one of the most authentic trials conducted has been largely disregarded possibly due to the forces of others whose objectives are of a different nature besides the restoration of the health of others.

 

My intrinsic pain has become annotated. Before my life was wrecked about 3 years ago, I was involved in pharmaceutical sales with very large corporations. I did this for about a decade. Before that career, I did patient care for about a (more...)
 

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