Abstract
BackgroundAntihypertensive medications are widely prescribed by doctors and heavily promoted by the pharmaceutical industry. Despite strong evidence of the effectiveness and cost-effectiveness of thiazide diuretics, trends in both promotion and prescription of antihypertensive drugs favour newer, less cost-effective agents. Observational evidence shows correlations between exposure to pharmaceutical promotion and less ideal prescribing. Our study therefore aimed to determine whether print advertisements for antihypertensive medications promote quality prescribing in hypertension.MethodsWe performed a cross-sectional study of 113 advertisements for antihypertensive drugs from 4 general practice-oriented Australian medical publications in 2004. Advertisements were evaluated using a quality checklist based on a review of hypertension management guidelines. Main outcome measures included: frequency with which antihypertensive classes were advertised, promotion of thiazide class drugs as first line agents, use of statistical claims in advertisements, mention of harms and prices in the advertisements, promotion of assessment and treatment of cardiovascular risk, promotion of lifestyle modification, and targeting of particular patient subgroups.ResultsThiazides were the most frequently advertised drug class (48.7% of advertisements), but were largely promoted in combination preparations. The only thiazide advertised as a single agent was the most expensive, indapamide. No advertisement specifically promoted any thiazide as a better first-line drug. Statistics in the advertisements tended to be expressed in relative rather than absolute terms. Drug costs were often reported, but without cost comparisons between drugs. Adverse effects were usually reported but largely confined to the advertisements' small print. Other than mentioning drug interactions with alcohol and salt, no advertisements promoted lifestyle modification. Few advertisements (2.7%) promoted the assessment of cardiovascular risk.ConclusionPrint advertisements for antihypertensive medications in Australia provide some, but not all, of the key messages required for guideline-concordant care. These results have implications for the regulation of drug advertising and the continuing education of doctors.
Highlights
Antihypertensive medications are widely prescribed by doctors and heavily promoted by the pharmaceutical industry
Hypertension is a major risk factor for cardiovascular disease [1] and the most common single problem managed in Australian general practice
[2] For more than a decade expensive new antihypertensive drugs have been prescribed more frequently than the older and more cost effective thiazide diuretics. [3,4,5,6] Newer antihypertensive drugs are among the highest volume and cost items for the Australian Pharmaceutical Benefits Scheme (PBS)
Summary
Antihypertensive medications are widely prescribed by doctors and heavily promoted by the pharmaceutical industry. Despite strong evidence of the effectiveness and cost-effectiveness of thiazide diuretics, trends in both promotion and prescription of antihypertensive drugs favour newer, less costeffective agents. Our study aimed to determine whether print advertisements for antihypertensive medications promote quality prescribing in hypertension. [19] The Australian National Medicines Policy (NMP) states that each partner (including the medicines industry) "accepts that all must be engaged in a cooperative endeavour to bring about better health outcomes for all Australians, focusing especially on people's access to, and wise use of, medicines." The NMP definition of "quality use of medicines" includes taking into account "the potential risks and benefits of treatment, dosage, length of treatment, and cost."[20] We believe evidence-based guidelines are a useful standard for evaluating how well advertisements support, rather than lead away from, wise use of medicine. The aim of our study was to determine whether print advertisements for antihypertensive medications in Australia promote prescribing for hypertension that is concordant with evidence-based guidelines. This study found 35% of the advertisements contained claims unsupported by evidence. [21] Our research builds on previous studies of advertisements and promotional brochures which have found overemphasis on relative statistical measures[22,23], and claims lacking clarity, accuracy, balance and substantiation. [22,23,24,25]
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