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Picking right blood pressure medicine challenging


3 Star

Picking right blood pressure medicine challenging

Our Review Summary

This  story provided  information on a very interesting topic: how to better assign medications to people with hypertension to maximize the treatment benefit and avoid medication-induced increases in blood pressure. The story tried to encapsulate insights from several studies and experts in the field about whether measurement of renin levels could really be useful in this regard.  It presented examples of how renin levels might be used by clinicians when prescribing blood pressure medications to patients. The story ultimately failed to explore the issues that would make use of renin measurement problematic.  In addition, the story did readers a disservice by casting diuretics as being "old and cheap," given that these are well-studied and proven medications that have had a tremendous impact on long-term clinical outcomes for patients with hypertension. 


Why This Matters

Optimizing medications to treat hypertension would be a boon to a huge patient population. In addition, people often take multiple medications to manage hypertension, and if the number of pills needed could be reduced or improved for at least some patients, this too would be useful.


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

  There was no discussion of costs, which is unfortunate.  One editorial in the journal containing the study mentioned that the $20 per sample analysis would be less than the cost of a year’s treatment even using the cheapest generic triple combination of drugs.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

 Other than to suggest that the use of the test could better assign medication for people with hypertension, the story did not provide an estimate for the number of people who would receive better tailored treatment or what the net result would be. One way to have addressed this would have been to explain how many heart attacks per 100 people with hypertension might be averted through better testing.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

  The story did not provide any indication about the downsides associated with testing.  Since the experts do not agree, then readers can conclude that some clinicians would prefer to stick with the “trial and error” method.  However readers were not informed as to how often the test incorrectly categorizes people.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

  The story tried to convey that there is some disagreement among experts in the field about whether renin level testing has any application for decisions about the class of medication to chose when treating hypertension.   However, other providing quotes from some of authors and experts, the story failed to provide readers with insight into the strengths and weaknesses of the studies reported on.

Does the story commit disease-mongering?


The story did not exactly engage in disease-mongering by indicating that the use of the wrong drug can trigger a jump in blood pressure, but it did poorly explain the phenomenon. Blood pressure can rise as the result of an ACE inhibitor triggering a narrowing of the blood vessels to the kidneys, but this is not common.  Similarly, the story could have done a better job of providing some context for understanding some of the data.  Instead of simply stating that 8% of individuals might see a 10 point increase in blood pressure when given a certain type of drug, it would have been more useful to provide readers with some idea about what that change in blood pressure could mean in terms of heart attack or stroke risk. 

Does the story use independent sources and identify conflicts of interest?


 The story included quotes from study authors and some experts in the field. The story also showed the researchers themselves putting the renin research into context. As the last line in the story notes, "Stay tuned: Despite his own renin findings, Mayo’s Turner says that hormone plays a small role in patient variability — and he’s hunting underlying genetic differences that might one day better guide treatment choice."

Does the story compare the new approach with existing alternatives?


 There story mentioned that doctors use trial and error to determine what medications to use to treat hypertension. The story ought to have provided some insight as to how often renin testing is used and if so, in what settings.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The story was actually somewhat vague as to whether testing to measure renin levels was currently available.  It would have been useful to let readers know that all of the medications and tests discussed in the story are available. The issue is that potentially more accurate and easier tests are being developed that might make testing for renin a more common occurrence. Although, as the story says up high, "Don’t expect a routine test for that hormone, called renin, any time soon. Many doctors are skeptical because initial research a few decades ago failed to show a clear benefit, says Dr. Ernesto Schiffrin of Canada’s McGill University, a hypertension specialist with the American Heart Association."

Does the story establish the true novelty of the approach?


The story did not make any claims as to the test for renin levels being either a new or unique approach, and it makes it clear that it is an area that has been studied and discussed over many years.

Does the story appear to rely solely or largely on a news release?


 The story does not appear to rely solely on a news release, and, in fact, the reporter should be applauded for going well beyond any one-study story and trying to pull together a range of studies and experts to present a fuller picture.

Total Score: 5 of 10 Satisfactory


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