Case Studies

An NIH study of treatments for high blood pressure, called the ALLHAT trial, shows some of the strengths and limitations of comparative effectiveness research to improve patient care. More...

Recent Blog Posts

PIPC chairman delivers speech to specialty docs on importance of patient centered CER
July 6, 2010 |

Partnership to Improve Patient Care (PIPC) chairman, Tony Coelho, recently delivered a speech on patient centered comparative effectiveness research (CER) in front of fifty specialty doctors from around the country, among others, at the Alliance for Specialty Medicine’s (ASM) “Capitol Hill Advocacy Conference.” The conference took place just a day before the specialty doctors met w

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Tony Coelho's recent speech on patient centered CER
June 24, 2010 |

Below: PIPC Chairman Tony Coelho's recent speech on patient centered CER. The speech was delivered on Tuesday, June 22, 2010 at the Alliance for Specialty Medicine's “Capitol Hill Advocacy Conference,” in Washington, D.C.

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Lack of support for "evidence-based health care"— don't blame the patient
June 10, 2010 |

A new Health Affairs article concludes, based on focus groups and interviews, that "consumers will revolt if evidence-based efforts are perceived as rationing or as a way to deny them needed treatment."

You don't need to look any further than public reaction to the U.S. Preventive Service Task Force's updated recommendations on mammography screening to see the proof of this.
 
How should policy-makers react? Should they conclude that consumers, and even more so, patients, cannot be relied on to make evidence-based decisions, and therefore these decisions need to be made for them? Or should they conclude that evidence-based models of medical care and health delivery need to be carefully constructed so they have the trust and support of patients and consumers?

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Hypertension

Cardiovascular disease is the number one cause of death among both men and women in the United States with nearly 2,500 deaths occurring daily. The term "cardiovascular disease" refers to a wide range of diseases that affect the heart and blood vessels. One of the leading causes of cardiovascular disease is hypertension. According to the Centers for Disease Control and Prevention (CDC), an estimated 1 of 3 American adults has hypertension.

What is hypertension?

According to the American Heart Association, roughly 73 million Americans have hypertension, or high blood pressure. The blood pressure level is determined by the level of force exerted by the circulating blood against the artery walls. The more blood the heart pumps and the narrower the arteries, the higher the blood pressure. In 2004, more than 54,000 people in the United States died as a result of high blood pressure. Hypertension usually develops over many years; however the danger of high blood pressure is that there are few symptoms, even at dangerously high levels. Uncontrolled blood pressure dramatically increases your risk of heart attack and stroke. Fortunately, due to advanced technology, high blood pressure is easily detected and can be controlled.

What progress has been made in hypertension treatment?

Over the years, the biopharmaceutical industry has developed nine classes of pharmaceuticals to treat hypertension including diuretics, beta-blockers, and inhibitors. These blood pressure medicines have significantly reduced the risk of stroke, heart failure, and death in elderly patients. According to The New England Journal of Medicine, elderly patients who were treated with blood pressure medicines had a 30% lower rate of stroke and a 64% lower rate of heart attack than those who took a placebo.

According to the Journal of the American Medical Association in 2007, the number of deaths caused by heart failure and heart attacks fell by nearly half between 1999 and 2005. This same study showed a direct correlation between increased use of cholesterol drugs, blood thinners, and angioplasties and a decrease in the development of congestive heart failure from 11 percent of heart attack patients in 2005 compared to 19.5 percent in 1999. According to Health Affairs, in 2007, the average blood pressure of adults over 40 years old would be 10 to 13 percent higher without the use of new antihypertensive drugs.

Recent studies indicate that blood pressure medicines, or antihypertensives, save lives and reduce hospitalization, specifically 86,000 lives and 833,000 hospitalizations each year. However, some experts predict that with additional disease education, prevention and treatment, the United States could avoid even more deaths and hospital stays attributed to high blood pressure-related illness. Currently, there are 36 new medicines in development for hypertension.

Timeline of Progress

1930s Physicians questioned if high blood pressure was a health risk, or needed for blood to circulate throughout the human body
1940s Physicians used treatments such as antimalarial agents, typhoid fever injections and adrenalectomy to lower blood pressure
1949 Diuretics first administered to effectively reduce elevated blood pressure
1964 First clinical trials for use of beta blockers to treat hypertension
1975 Development of captopril, the first orally-active ACE inhibitor for treatment of hypertension
1981 Captopril approved by the U.S. Food and Drug Administration (FDA)
1990 Development of the first direct renin inhibitor to successfully treat high blood pressure.
2005 Heart disease, including high blood pressure, named leading cause of death in the U.S.
2007 Aliskiren approved by the FDA for the treatment of primary hypertension
2008 36 new medicines in development for hypertension