[e-drug] Thiazides and high blood pressure

["Leo Offerhaus" <offerhausl@euronet.nl>]

E-DRUG: Thiazides and high blood pressure
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Dear all,

It is a curious phenomenon that this debate has been raging for the 
last fifty years and that nobody knows the real answer: "salt or no 
salt", basically the Platt vs Pickering controversy. But - from the 
point of view of E-Drug - does it really matter? And should we mix 
scientific and commercial/political arguments at this level? What is 
important is that these drugs work, and that they are cheap and 
widely available. 

Of course there are some racial and generic differences, and we should take these into account. What we have to know is what the lowest effective dose is, and there are some excellent studies showing that these drugs have a very flat dose-response curve (as to the diuretic effect - the hypotensive effect lasts much longer because is linked to homeostatic mechanisms)  and that therefore higher doses which we have used in the past and have caused problems (diabetes, hypopotassaemia) are no longer appropriate. 

I don't believe that manufacturers of thiazides are really interested in putting political or commercial pressure on manufacturers of newer classes of drugs - there are too many of them, 
all of them are in the generic business and the profit margin is minimal. So we all agree that these drugs are cheap and effective, and that the differences between them are decided by dose and price. 

NICE advice is aimed at the British government and British prescibers solely and should not be applicable to developing countries with restricted resources. The whole discussion is not 
worth the salt (what's in a name....).

Regards,

Leo Offerhaus, the Netherlands.
Leo Offerhaus <offerhausl@euronet.nl>