Healthy Skepticism Library item: 20085

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Magazine

Montgomery B, Mansfield PR
Thiazide, please
Australian Doctor 2005 Apr 1531

Full text:

Editor The hype about the ASCOT results in your story ‘New drugs best for hypertension’ (18 March) could lead readers to throw the baby (thiazides) out with the bathwater (atenolol).

The early ASCOT finding of better mortality results for amlodipine (with or without perindopril) than atenolol (with or without bendrofluazide) deserves healthy scepticism. A recent Lancet meta-analysis proved antenolol was inferior to other antihypertensive in terms of mortality, casting doubts on its use in hypertension and, importantly, its use as a comparator in trials. So it’s no surprise that the atenolol group fared worse in ASCOT.

It is vital that we don’t tar the thiazides with the same brush as atenolol. After all, the ALLHAT trial showed that chlorthalidone can’t be beaten as a first-line choice in hypertension. We should also remember that the opportunity costs of unnecessary, expensive newer drugs include reduced access to services our patients need more.

What do we want if we get hypertension? A thiazide first, please.