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Use of alpha-Blockers for Hypertension Declined After Publication of Unfavorable Clinical Trial Results
Journal of the American Medical Association (JAMA)
01/06/2004
By Joene Hendry
The use of alpha-blockers for the treatment of hypertension steadily increased from 1996 through 1999, then began to decline after January 2000 when the findings of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) revealed the alpha-blocker doxazosin carried a risk of combined cardiovascular events 25% higher than patients treated with a thiazide diuretic.
"The lack of an abrupt and more pronounced decline in prescribing shortly after the ALLHAT results, however, suggests slow and potentially incomplete diffusion of information from this clinical trial," writes Randall S. Stafford, MD, PhD, Stanford University, California, the United States, and colleagues. They analysed the trends in prescribing and dispensing of alpha-blockers as related to publication of the ALLHAT findings or other possible influences.
Annual alpha-blocker use increased 9% from 1996 to 1999, according to office-based physicians from the National Disease and Therapeutic Index, and then decreased by 54% through 2002. Data from IMS HEALTH's National Prescription Audit Plus revealed that annual new alpha-blocker prescriptions increased from 4.90 million in 1996 to 5.15 million in 1999, and then declined by 26% to 3.79 million in 2002.
Data from IMS HEALTH's Integrated Promotional Service: Office Promotion Report reveals a 47% increase in expenditures for office-based promotion of alpha-blockers - from $6.3 million during the first quarter of 1996 to $9.3 million in the third quarter of 1998. Such expenditures declined to $7.3 million by the third quarter of 1999 and to $4.0 million by the third quarter of 2000. The authors report, "By the first quarter of 2001, no alpha-blockers were being promoted on the market."
The authors suggest that publication of the ALLHAT data had a significant impact on alpha-blocker use but note that, "declining pharmaceutical industry promotion also may have contributed further to decreased alpha-blocker use."
JAMA 2004;291:54-62.
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