Adverse drug effects, compliance, and initial doses of antihypertensive drugs recommended by the Joint National Committee vs the Physicians' Desk Reference

Background: Compliance problems are common causes of the inadequate treatme nt of hypertension, with 16% to 50% of patients quitting treatment within 1 year. Dose-related adverse drug events (ADEs) frequently cause compliance problems, and many ADEs occur with the initial doses of antihypertensive dr ugs. Thus, it is an established tenet to initiate antihypertensive therapy at low doses to avoid ADEs that diminish patients' quality of life and redu ce compliance. However, what are the lowest effective doses of antihyperten sive drugs? Objective: To compare the initial doses recommended in the Physicians' Desk Reference (PDR) with those recommended by the Sixth Report of the Joint Na tional Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Methods: Review of the latest JNC VI report (1997) and the 1999 and 2000 ed itions of the PDR and the medical literature. Results: The INC VI recommends substantially lower initial doses for 23 (58 %) of 40 drugs, compared with the PDR. In addition, for 37 (82%) of 45 drug s, PDR guidelines do not suggest lower initial doses for old or frail patie nts than for younger adults. Conclusions: Although the PDR is the drug reference most used by physicians , it does not reflect the lowest initial doses that are recommended by the JNC VI for many of the most prescribed antihypertensive drugs. Because avoi dance of ADEs is essential to maintaining compliance with antihypertensive therapy, and because many antihypertensive ADEs are dose related, physician s must know the very lowest, effective, least ADE-prone doses. Patients and physicians would benefit by establishing mechanisms to make this informati on readily available to all practicing physicians.