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Doctors substantially reduced their prescribing of alpha-blockers for hypertension after published trial results showed problems

In Spring 2000, significant changes in recommendations for alpha-blocker use occurred as a result of early, unfavorable results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Trial results indicated an increased risk and lower effectiveness of the alpha-blocker doxazosin mesylate compared with diuretics. These results, widely disseminated in news releases and journal publications, resulted in a substantial decline in alpha-blocker prescribing by U.S. physicians, according to a study supported by the Agency for Healthcare Research and Quality (HS13405).

There were steady increases in alpha-blocker new prescriptions, dispensed prescriptions, and physician drug use from 1996 through 1999. However, between 1999 and 2002, new annual alpha-blocker prescription orders declined by 26 percent (from 5.15 million to 3.79 million), dispensed prescriptions by 22 percent (from 17.2 million to 13.4 million), and physician-reported alpha-blocker use by 54 percent (from 2.26 million to 1.03 million). Other potential influences did not appear to have contributed significantly to this decline, although cessation of alpha-blocker marketing may have hastened the decline, explains Stanford University researcher, Randall S. Stafford, M.D., Ph.D.

Findings by Dr. Stafford and his colleagues were based on analysis of two national pharmaceutical market research reports (available from IMS Health, Plymouth Meeting, PA). These included the alpha-blocker prescription orders reported in the National Prescription Audit Plus—a random computerized sample of 20,000 to 29,000 retail, independent, and mail order pharmacies and mass merchandise and discount houses—along with office-based physician alpha-blocker prescribing patterns reported in the National Disease and Therapeutic Index, a random sample of 3,500 physician offices.

See "Impact of clinical trial results on national trends in alpha-blocker prescribing, 1996-2002," by Dr. Stafford, Curt D. Furberg, M.D., Ph.D., Stan N. Finkelstein, M.D., and others, in the January 7, 2004, Journal of the American Medical Association 291(1), pp. 54-62.

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