Navigation Links
Black patients with hypertension not prescribed diuretics enough
Date:1/22/2013

NEW YORK (January 22, 2013) -- A research study of more than 600 black patients with uncontrolled hypertension found that less than half were prescribed a diuretic drug with proven benefit that costs just pennies a day, report researchers at Weill Cornell Medical College and the Visiting Nurse Service of New York's (VNSNY) Center for Home Care Policy and Research. The researchers say these new findings should be taken as a serious wake-up call for physicians who treat black patients with hypertension.

Their study, reported in the American Journal of Hypertension, found that the patients in the study who used the common diuretic drugs had, on average, lower blood pressure (both systolic and diastolic) than the patients who did not receive them.

"We were surprised to find that this beneficial and low-cost drug was not being prescribed for more patients who would benefit from it," says the study's lead investigator, Dr. Linda Gerber, a professor of public health and director of the Biostatistics and Research Methodology Core at Weill Cornell Medical College.

Many previous studies have shown that diuretics are particularly helpful in black patients with hypertension and should be used as first or second-line treatment -- findings that have been written into treatment guidelines. Also, several recent clinical trials have reported that newer classes of agents are not superior to the older diuretic agents, especially in blacks. Newer drugs for hypertension include angiotensin-converting enzyme inhibitors (ACEs), angiotensin-receptor blockers (ARBs) and calcium-channel blockers (CCBs).

"Yet, we find that physicians are not using the drugs as they should in a population that is especially hard hit by high blood pressure, and who suffer greater prevalence, severity, organ damage and mortality from the disease compared to other groups," says Dr. Gerber, who is also a professor of epidemiology in medicine at Weill Cornell.

While Dr. Gerber did not speculate on why this phenomenon is occurring since doctors were not interviewed as part of this research, study co-author, Dr. Samuel Mann, a professor of clinical medicine at Weill Cornell and a hypertension specialist at the Hypertension Center of NewYork-Presbyterian HospitalWeill Cornell Medical Center, has some theories.

"Guidelines are not rules and they are not enforceable, and some physicians may worry about potential side effects of diuretics -- which, although not uncommon, are not a major problem. And in patients with uncontrolled hypertension, the benefit of treating with a diuretic far outweighs the risk of side effects that are generally very manageable," says Dr. Mann. "Also, newer drugs are promoted much more aggressively than diuretics. However, many studies show that diuretics work very well, particularly in black patients, so between their effectiveness and low cost, their use should be a no-brainer."

The Weill Cornell research team worked in close collaboration with researchers from the VNSNY Center for Home Care Policy and Research, who received funding support from the National Heart, Lung and Blood Institute (NHLBI) to seek ways to improve hypertension management and outcomes. 658 black patients receiving home care were enrolled in the study; all had uncontrolled hypertension defined as 140/90 or above (130/80 or above if they were diabetic). Although the patients were receiving post-acute care from a single health organization, their prescribing providers came from a wide variety of medical settings.

"Communicating effectively with patients' physicians and persuading them to review the medications of patients with uncontrolled hypertension is an ongoing challenge for home care nurses," says study co-author Dr. Penny Feldman, director of the VNSNY Center for Home Care Policy and Research and senior vice president for Research and Evaluation at VNSNY. "Our study shows that close monitoring of patient medications can help identify inconsistencies and divergence from current approved medical guidelines and make inroads to help improve the health and quality of life of black patients with hypertension."

Study investigators found that 5.5 percent of participants were not prescribed any antihypertensive drugs, and that only 46 percent were prescribed a diuretic. They also discovered that participants who were not taking a diuretic had systolic and diastolic blood pressures that were, on average, five and four millimeters higher, respectively, than those who were taking a diuretic.

"A majority of patients surveyed were taking multiple drugs for hypertension, as many as three or four, and many of those still were not taking a diuretic," says Dr. Gerber. "The absence of diuretic use in the regimen of more than half of the patients in this study is contrary to guidelines and may be harmful to patients, both medically in terms of uncontrolled hypertension, and economically, in terms of medication cost and compliance."

Dr. Gerber adds that a strength of the study is that "it focuses on members of an undertreated and understudied population whose high blood pressure has proven particularly damaging, and for whom guidelines strongly recommend a diuretic as a mainstay of treatment."


'/>"/>

Contact: Lauren Woods
Law2014@med.cornell.edu
646-317-7401
Weill Cornell Medical College
Source:Eurekalert

Related medicine news :

1. High Blood Pressure May Be Especially Lethal for Blacks
2. Hispanic lung cancer patients tend to live longer than blacks and whites
3. Health Care Disparities Might Affect Black Kids Cancer Survival
4. Study says screening accounts for much of black/white disparity in colorectal cancer
5. Blacks and Hispanics at higher risk for precancerous colorectal polyps
6. Blacks Less Likely to Get Help on Scene After Cardiac Arrest: Study
7. Eye Changes May Predict Heart Disease in Blacks With Diabetes
8. Quality of care, other issues may cause worse results in black prostate cancer surgery patients
9. Blacks, Hispanics Have Higher Colon Polyp Risk Than Previously Thought
10. Exercise Controls Weight in White Girls Better Than in Black Girls: Study
11. 9 in 10 Blacks With High Blood Pressure Have Early Heart Disease
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/12/2017)... ... October 12, 2017 , ... Planet Fitness, one of the largest ... its plans to open a flagship location in Covington, LA at 401 N. U.S. ... Go store next to Office Depot in the Holiday Square shopping center. Its location ...
(Date:10/12/2017)... ... 12, 2017 , ... IsoComforter, Inc. ( https://isocomforter.com ), one of ... innovative new design of the shoulder pad. The shoulder pad provides optimal support ... your pain while using cold therapy. By utilizing ice and water that is circulated ...
(Date:10/12/2017)... ... , ... Asante, a nationally recognized health system in southern ... home health joint venture through an agreement, effective October 1, 2017, to create ... health company with Asante, delivering clinically integrated care, for the past eight years. ...
(Date:10/12/2017)... , ... October 12, 2017 , ... ... Hair Restoration, has recently contributed a medical article to the newly revamped ... Dr. Mohebi’s article spotlights the hair transplant procedure known as Follicular Unit ...
(Date:10/12/2017)... ... ... Leading pediatric oncology experts at Children’s National Health System will ... the International Society of Paediatric Oncology (SIOP) Oct. 12-15. Chaired by Jeffrey ... Disorders at Children’s National, and Stephen P. Hunger, M.D., Chief of the Division ...
Breaking Medicine News(10 mins):
(Date:9/19/2017)... HistoSonics, Inc., a venture-backed medical device company developing a non-invasive, robotically assisted, platform therapy that ... developments today:   ... ... Tom Tefft ... Veteran medical device executive Josh Stopek , PhD, who has led R&D and ...
(Date:9/18/2017)... 18, 2017 EpiVax, Inc. ("EpiVax") ... and immune engineering, today announced a new ... (H7N9) vaccine. ... influenza and presents a challenge for traditional ... to be effective. Using state-of-the-art bioinformatics and molecular ...
(Date:9/12/2017)... , Sept. 12, 2017  Consumer reviews on the independent ... as the number one company for hearing aids, ranking it ... fifteen other brands. ... Hearing Named #1 by Consumers For Hearing Aids ... Embrace Hearing is an online store that provides high performance, ...
Breaking Medicine Technology: