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Trial of New Blood-Pressure Medication Brought to a Halt

March 13, 2000|THOMAS H. MAUGH II

The government has halted a large trial of a new hypertension drug because preliminary results indicated that an older, cheaper drug works better and is safer.

The National Institutes of Health said Wednesday that patients taking the new drug, an alpha-adrenergic blocker, should talk to their physicians about switching medications.

The study involved doxazosin, trade name Cardura, but Dr. Jeffrey Cutler of the National Heart, Lung and Blood Institute said the results should also apply to other alpha-adrenergic blockers, including terazosin (Hydrin) and prazosin (Minipress). Of the 24 million Americans taking blood-pressure drugs, an estimated 1 million are using alpha-adrenergic blockers. Researchers cautioned that the drugs should not be confused with calcium-channel or beta blockers, which are very effective. The three drugs work by different mechanisms.

In the study, researchers compared doxazosin to the diuretic chlorthalidone. The researchers found that patients taking doxazosin had slightly higher blood pressure than those taking chlorthalidone, had 25% more cardiovascular events, such as heart attacks, and were twice as likely to be hospitalized for congestive heart failure. Further information is available at http://www.nhlbi.nih.gov.

Study Backs Efficacy of Beta Blockers

More evidence of the efficacy of beta blockers in heart disease was presented in Wednesday's Journal of the American Medical Assn.

A study from the Sahlgrenska University Hospital in Gothenburg, Sweden, reported in June that use of the beta blocker metaprolol reduced deaths by 34% in patients suffering from congestive heart failure. The new report from the same study documents additional benefits from the drug, trade name Toprol XL.

The Swedish team followed 3,991 heart-failure patients in the United States and 13 European countries for an average of one year. About half were given metaprolol and half a placebo. Not only were there fewer deaths in the group given metaprolol, compared to those given a placebo, but there were about a third fewer hospitalizations.

Symptoms improved in 28.6% of the beta-blocker group, compared to 25.8% in the control group. Further, 50% of the beta-blocker group reported feeling better, compared to 40% of the control group. A related editorial in the journal noted that fewer than 30% of eligible patients are now being treated with the drugs.

Toprol XL is awaiting approval by the Food and Drug Administration for treating heart failure. The only beta blocker currently approved for that purpose is carvedilol, trade name Coreg.

Wrong Clot-Buster Doses Cited in Deaths

As many as 1,500 heart-attack victims die needlessly each year and 21,000 others suffer adverse effects because clot-busting drugs are not administered properly, according to researchers from Brigham and Women's Hospital in Boston.

Typical mistakes include giving the wrong amount of the drugs or not timing multiple doses properly, and women were most likely to fall victim to the errors.

The clot-busting drugs, including tPA, streptokinase and Retavase, are routinely given to heart-attack victims who arrive at an emergency room within six hours of a heart attack. The drugs dissolve the clot, restoring blood flow to the heart. An estimated 260,000 patients received the drugs last year. Problems arise because the dose must be adjusted for the patient's weight and because administration schedules can be complex. For example, two infusions of tPA are required, the first for 30 minutes and the second for 60 minutes.

Dr. Christopher Cannon and his associates reviewed the treatment of more than 50,000 patients in several clinical trials of the drugs. They reported Saturday at an American College of Cardiology meeting in Anaheim that errors were common nonetheless. Among patients receiving tPA, for example, 11% of women and 6.3% of men received the wrong dose. Women were more likely to receive the wrong dose because they typically weigh less and should receive a smaller dose.

Overall, Cannon reported, the death rate was 7% to 8% if the drugs were given properly and double that if mistakes were made.

Problems Seen With Seed Therapy for Cancer

Radioactive seeds (small pellets containing radioactive isotopes) implanted in the prostate to kill cancer cells can impact quality of life much more than physicians previously believed, according to a new UCLA study.

Dr. Robert Reiter and his colleagues at UCLA's Jonsson Cancer Center studied 48 prostate cancer patients who received the radioactive seeds and 74 patients who underwent surgery to remove the tumor.

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