 |
|
Adverse Drug Effects, Compliance, and Initial Doses of Antihypertensive Drugs Recommended by the Joint National Committee vs the Physicians' Desk Reference
Jay S. Cohen, MD
Arch Intern Med. 2001;161:880-885.
Background Compliance problems are common causes of the inadequate treatment of
hypertension, with 16% to 50% of patients quitting treatment within 1 year.
Dose-related adverse drug events (ADEs) frequently cause compliance problems,
and many ADEs occur with the initial doses of antihypertensive drugs. Thus,
it is an established tenet to initiate antihypertensive therapy at low doses
to avoid ADEs that diminish patients' quality of life and reduce compliance.
However, what are the lowest effective doses of antihypertensive drugs?
Objective To compare the initial doses recommended in the Physicians' Desk Reference (PDR) with
those recommended by the Sixth Report of the Joint National Committee on the Detection, Evaluation, and Treatment of High
Blood Pressure (JNC VI).
Methods Review of the latest JNC VI report (1997) and the 1999 and 2000 editions
of the PDR and the medical literature.
Results The JNC VI recommends substantially lower initial doses for 23 (58%)
of 40 drugs, compared with the PDR. In addition,
for 37 (82%) of 45 drugs, PDR guidelines do not suggest
lower initial doses for old or frail patients than for younger adults.
Conclusions Although the PDR is the drug reference most
used by physicians, it does not reflect the lowest initial doses that are
recommended by the JNC VI for many of the most prescribed antihypertensive
drugs. Because avoidance of ADEs is essential to maintaining compliance with
antihypertensive therapy, and because many antihypertensive ADEs are dose
related, physicians must know the very lowest, effective, least ADE-prone
doses. Patients and physicians would benefit by establishing mechanisms to
make this information readily available to all practicing physicians.
From the Department of Family and Preventive Medicine, University of
California– San Diego, La Jolla.
RELATED LETTERS
PDR Provides Latest Food and Drug Administration–Approved Dosage Guidelines
Mukesh Mehta
Arch Intern Med. 2001;161(21):2622.
EXTRACT
| FULL TEXT
Cohen vs PDR
Russell A. Rohde
Arch Intern Med. 2001;161(21):2622-2623.
EXTRACT
| FULL TEXT
Start Low, Go Slow, Is Not Always Best
Daniel Reinharth and Jay S. Cohen
Arch Intern Med. 2001;161(21):2623.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Persistence with Treatment in Newly Treated Middle-Aged Patients with Essential Hypertension
Perreault et al.
The Annals of Pharmacotherapy 2005;39:1401-1408.
ABSTRACT
| FULL TEXT
Antidepressants: An Avoidable and Solvable Controversy
Cohen
The Annals of Pharmacotherapy 2004;38:1743-1746.
FULL TEXT
Primary Prevention of Type 2 Diabetes Mellitus by Lifestyle Intervention: Implications for Health Policy
Centers for Disease Control and Prevention Primary
ANN INTERN MED 2004;140:951-957.
ABSTRACT
| FULL TEXT
Improving Adherence and Reducing Medication Discrepancies in Patients with Diabetes
Grant et al.
The Annals of Pharmacotherapy 2003;37:962-969.
ABSTRACT
| FULL TEXT
Addressing Dosing Frequency in Diabetes: A Simple Approach to Improving Adherence to Therapy and Clinical Outcomes
Morris
The Diabetes Educator 2003;29:440-453.
Why Aren't Lower, Effective, OTC Doses Available Earlier by Prescription?
Cohen
The Annals of Pharmacotherapy 2003;37:136-142.
ABSTRACT
| FULL TEXT
Timing of New Black Box Warnings and Withdrawals for Prescription Medications
Lasser et al.
JAMA 2002;287:2215-2220.
ABSTRACT
| FULL TEXT
PDR Provides Latest Food and Drug Administration-Approved Dosage Guidelines
Mehta
Arch Intern Med 2001;161:2622-2622.
FULL TEXT
Start Low, Go Slow, Is Not Always Best
Reinharth and Cohen
Arch Intern Med 2001;161:2623-2623.
FULL TEXT
Cohen vs PDR
Rohde
Arch Intern Med 2001;161:2622-2623.
FULL TEXT
Dose Discrepancies Between the Physicians' Desk Reference and the Medical Literature, and Their Possible Role in the High Incidence of Dose-Related Adverse Drug Events
Cohen
Arch Intern Med 2001;161:957-964.
ABSTRACT
| FULL TEXT
|
