Press release

Why do patients with high blood pressure stop using their medication?

p. 31  Persistence with treatment for hypertension in actual practice — J. Jaime Caro, MD, CM; Maribel Salas, MS, MD; et al [abstract / résumé]

p. 41  Effect of initial drug choice on persistence with antihypertensive therapy: the importance of actual practice data — J. Jaime Caro, MD, CM; Jeanne L. Speckman, MSc; et al [abstract / résumé]

p. 64  Compliance in hypertension: Why don't patients take their pills? — Martin G. Myers, MD [full text]

With proper treatment, patients with high blood pressure can reduce their risk of heart attack and stroke. If that's the case, why are so many refusing to take their medication? In a new study of 27 364 adults with newly diagnosed hypertension, more than 20% stopped taking their drugs by the end of the first year of therapy. Using the Saskatchewan administrative database, Jaime Caro and colleagues tracked the use of medication by almost 80 000 hypertensive patients for 1 year.

In a companion paper, the authors discovered that long-term compliance was related to the class of drug initially prescribed. At 6 months after diagnosis, 20% of patients for whom a diuretic was initially prescribed were not taking any antihypertensive drug. Angiotensin-converting-enzyme (ACE) inhibitors had marginally higher compliance rates (11%) than other classes of drugs .

In an editorial perspective on these important studies, Martin Meyer reports on several reasons for noncompliance including negative societal attitudes toward taking drugs and the abundance of information now available about side effects. Physicians can help address these problems by prescribing longer-acting, less expensive medications and providing more balanced information.

p. 61  Medical thunder is required to stir the Chrétien government — Frederic Bass, MD, DSc [full text]

The federal government has reneged on its 1994 promise for "the largest antismoking campaign this country has ever seen." Despite annual tobacco tax revenues of more than $2 billion, the government only spent $10 million on tobacco control in 1997. Meanwhile, Dr. Frederic Bass writes, there is a "tobacco epidemic" among women, whose mortality rate from lung cancer has more than tripled since 1969. "In Canada the tobacco industry has been a vicious predator, and the federal government remains entrenched in a passive, symbiotic, fiscal partnership with that predator," Bass states.

p. 49  Current and projected annual direct costs of screening asymptomatic men for prostate cancer using prostate-specific antigen — Murray D. Krahn, MD, MSc; B. Ann Coombs, MSc; Isra G. Levy, MD, MScP [abstract / résumé]

p.70  Prostate-specific antigen testing in Ontario: reasons for testing patients without diagnosed prostate cancer — Peter S. Bunting, PhD; Vivek Goel, MD et al [abstract / résumé]

How expensive is prostate-specific antigen (PSA) testing? Expensive, but less so than previously reported. Murray Krahn and colleagues report the actual estimated cost of PSA screening in Canada during 1995 was $45 million. If all eligible men in Canada had been screened with PSA tests in 1995, the cost would have been $317 million — more than the cost of all prostate cancer care provided in Canada that year. The authors expect that the actual cost will rise to $66 million by 2000. Even so, they predict that the cost of PSA screening will account for less than 0.15% of Canada's direct health care costs, a much smaller proportion than previously reported.

Despite the costs, Peter Bunting and colleagues found that most physicians order PSA tests to screen for prostate cancer, often at the patient's request. In their Toronto area survey of more than 200 physicians caring for patients without diagnosed prostate cancer, Peter Bunting and colleagues found that 63% ordered PSA tests to screen for prostate cancer, 40% to investigate urinary symptoms and 33% to follow up a medical procedure or drug therapy. Tests for screening were initiated by the patient in 63% of cases. There also appear to be important differences across specialties, with urologists and family physicians tending to differ in their reasons for ordering a PSA test.