[e-drug] Thiazides and high blood pressure (3)

["Peter Mansfield" <peter.mansfield@adelaide.edu.au>]

E-DRUG: Thiazides and high blood pressure (3)
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Dear Dr Mrs B.A.Aina,

I agree that price is very important. 

I am not aware of any good evidence to support using the expensive new antihypertensive drugs except the HOT trial which showed benefit for diabetics from aiming for a lower blood pressure target by adding an ACE inhibitor. However there was a trend for harm for non-diabetics. Consequently it is not clear that we should use the more expensive drugs even for people who can afford them. 

The drug that I recommend, clorthalidone is an old off patent drug so it should be about the same price as hydrochlorothiazide. In fact, in my country (Australia) clorthalidone is about half the price of hydrochlorothiazide. 

I don't know how the prices compare in Nigeria but I know clorthalidone has been available in Nigeria because it was used in the following studies.

Salako LA, Falase AO, Aderounmu AF, Walker O. Assessment of a fixed-dosage combination of atenolol and chlorthalidone (Tenoretic) in hypertensive Nigerians.
Afr J Med Med Sci. 1990 Mar;19(1):57-61. 
(NB one of the control groups took chlorthalidone alone.)

Mabadeje AF. The use of low dose of chlorthalidone in hypertensive Nigerians.
Niger Med J. 1979 Jul-Aug;9(7-8):755-8.

regards,

Peter

Dr Peter Mansfield
GP
Director, Healthy Skepticism Inc
Countering misleading drug promotion.
www.healthyskepticism.org
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Research Fellow, Discipline of General Practice, University of Adelaide
peter.mansfield@adelaide.edu.au
See publication list at:
www.adelaide.edu.au/directory/peter.mansfield