The Boston Globe offers interesting short summaries of health/medical/science topics. This one presents the results of a recent study of a drug called candesartan in people who have pre-hypertension to prevent hypertension. It was really a study of this drug in addition to the usual lifestyle recommendations (DASH diet, weight loss, reduced sodium, physical activity and moderation of alcohol intake). But the story didn’t make this clear and gave the lifestyle changes little attention. The story did not provide a framework for understanding how often pre-hypertension progresses to hypertension. The story could have (should have?) stressed that, while the drug may prevent pre-hypertension from turning into hypertension, that does not tell us if this early treatment reduces hard clinical outcomes (stroke, heart attack, peripheral vascular disease and mortality). Without this information, it is not possible for people to determine whether they should take action regarding a pre-hypertensive state and if so, to make a balanced assessment of the relative risks and benefits of the treatment options available.
The story didn’t provide any cost estimate for candesartan. It did mention that there was a need to conduct analysis examining the risk to benefit ratio including costs.
The story stated that “They found that during the study, patients who received candesartan were 66 percent less likely to develop true hypertension than those who received the placebo.” That’s a relative risk reduction (or benefit, depending on how you view it); but readers would be better guided by the absolute risk reduction figures.
Fainting and abnormal potassium levels were mentioned as harms of treatment, though there was no indication of how common these harms might be. Another harm not mentioned was that it is known from other studies that labeling someone as ‘hypertensive’ can severely affect their quality of life (self perception).
The story clearly identifies that the evidence comes from a publication in the April 20th issue of the New England Journal of Medicine.
While this article does not frame pre-hypertension as a disease per se, it does suggest its ‘treatment’ will prevent development of hypertension. But the story doesn’t give any context for the percentage of people with pre-hypertension who actually go on to develop hypertension. The drug may prevent pre-hypertension from turning into hypertension, but the story does not tell us if this early treatment reduces hard clinical outcomes (stroke, heart attack, peripheral vascular disease and mortality).
Less than optimum: The sole source of this article appears to be a New England Journal of Medicine article. No additional sources were apparent.
Strong point: The story stated, “CAUTIONS: This study was funded by AstraZeneca the maker of candesartan and the company was also involved in the analysis of the data.”
Although two of the lifestyle recommendations for management of pre-hypertension (i.e. low-salt diet and regular exercise) were mentioned, the article relied on the New England Journal of Medicine article for estimates for the efficacy of lifestyle interventions to reduce hypertension instead of studies of these (and other lifestyle) interventions. Individuals receiving either the drug or placebo in this trial also received printed materals about lifestyle modifications and review and reinforcement of diet and exercise at all visits. This means that the study was really about the potential benefit of the drug in addition to usual lifestyle recommendations. That should have been made clear.
The story is about a trial of a drug called candesartan, which is currently approved for treating hypertension. Researchers studied it for managing a condition that is now called pre-hypertension. But the story didn’t make clear where the drug stood with the FDA for approval for the use described in the article.
It’s fairly clear from the story that the use of medication as a means of reducing the risk of developing hypertension in patients with pre-hypertension but without other conditions is new.
Does not appear to rely on the press release from AstraZeneca distributed when the study was presented at the American College of Cardiology meeting.