Monday, May 04, 2009


Over the weekend, I help organise and also participate in a CME for physicians and paediatricians, at the Legend Hotel. I had planned sessions including three, for the management of HBP, delivered by 1, a senior consultant cardiologist in an institution, 2. a senior consultant cardiologist in private practice and 3. a nephrologist in another institution. Is was refreshing, to say the least, to hear how HBP was managed in three different practice environment. Some are clearly number driven ( control BP to target ), and some are more practical and down to earth, so as to get compliance and better control. Some are charts, graphs driven ( as to proved evidence bsed medicine ). Even the same studies quoted by the different speakers could be interpreted in so many different ways. No wonder the treatment of HBP is in such a mess. I have often wondered how much this contributed to the poor level of adequate control ( 6-8% of all HBP diagnosed ) that exist in our community. It is amazing how we cannot get together for the greater good and agree on simple strategies, so that we can get out cler messages and perhaps this will enhance the level of adequate control.
I would like to think, that just one approach will never be possible because the patients are varied and they have individual factors in their HBP control their mandates one approach over another or one prefered drug over another. I am also certain that the pharmas will not like just one, or even two strategies as some may lose out.
However, over the weekend, I think that we can agree that in patients with HBP, lifestyle modification including losing weight and eating less salt, is important. We must always risk startify our patients, and look for target organ damage, or the lack of target organ damage. Drugs are obviously important. Often, one may need two or even three drugs for adequate control. That of course will bring up the issue of cost and compliance.
In this regard, it is worth nothing that we should see the advent of more pharmas bring in combo pills, in an attempt to lower drug cost and also to help increase complaince. Novartis, when they launch Exforge and when Exforge, receive FDA approval as a second line drug for the management of HBP, made plenty of money. Exforge was very succesful. Now Novartis has just receive FDA approval for another combo pill for HBP, which will essentially be Exforge + a diuretic ( or you can also call it Co-Diovan + CCB ).
I also know ( I have been asked their value ) that many other companies will be doing the same ( bring out more combo pills for HBP ). There should be more ACE-I + CCB combinations coming soon and also ARB + CCB combination.
All these will be good as I hope that it will lower cost, increase complaince and so improve on the number of HBP that will be treated to target.
I also wish to emphasize that although numbers ( levels of control ) are important, treating to lessen and reverse target organ damage and also reducing MACCE ( major adverse cerebral and cardiovascular events ) is even more important. At the end of the day, for all clinicians, it is the patient and what happens to him after 5-10years that is important, and not just numbers.

1 comment:

pilocarpine said...