Published: 16/09/2004, Volume II4, No. 5923 Page 21
We welcome the inclusion of clinical topics in HSJ.However, the recent article by Dr Nick Summerton on the choice of blood-pressure lowering drugs makes, in our view, a number of statements which are misleading, unsubstantiated and at odds with current clinical guidelines ('Your money or their life', pages 24-25, 15 July).
For example: 'The angiotensin receptor blockers represent a major advance in the management of cardiovascular disease.' In many conditions there is no evidence that they save more lives than older, existing drug groups.
Writing specifically about heart failure, Dr Summerton highlights that in the VALUE trial, an ARB drug (valsartan) prevented more hospital admissions than calcium channel blocker amlodipine. It should have been made clear that this was a secondary outcome of the trial and that for the primary outcome, a composite endpoint of cardiac morbidity and mortality, there was no significant difference between the two drugs over the 4.2-year study.
In a further comparison of the same drug classes, the findings of a sub-group of the VALIANT trial are cited with no indication that the difference between the drug groups was not statistically significant. Coverage of the LIFE trial is similarly incomplete - in this study, patients were a highly selected group not typical of most patients treated by GPs.
We would recommend readers to consult clinical guidelines produced by the National Institute for Clinical Excellence.
In its latest guideline on hypertension, thiazide diuretics (the cheapest and oldest drug class) are the first choice for lowering blood pressure in most patients, a recommendation based on a sound analysis of the 20,000-patient ALLHAT trial.
Andrew Martin Programme director medicines management Mark Campbell Director of clinical governance Bury PCT