Analysis: Abbreviation hurting care?

CHICAGO, May 23 (UPI) -- Doctors suggested that a simple abbreviation for a commonly prescribed high blood pressure drug may result in patients receiving an inferior product.

HCTZ is the accepted abbreviation for the generic diuretic drug hydrochlorothiazide, and diuretics are the backbone of most treatments for hypertension, the formal name for high blood pressure, the disease that is linked to heart attacks, stroke and kidney failure.

In a presentation at the 22nd annual meeting of the American Society of Hypertension, William Elliott, professor of medicine at Rush Presbyterian St. Luke's Medical Center in Chicago, told United Press International, "I'm not joking about this issue. It is easier for doctors to write HCTZ than to write chlorthalidone, even though study after study has shown that chlorthalidone is a better drug."

It is not an issue of cost either, Elliott added. "Both of these drugs are generics and can be found in the Wal-Mart list of 'under-$4-a-month' drugs," he said.

Yet by far, more patients are written prescriptions for hydrochlorothiazide because it can be abbreviated as HCTZ, a recognized shorthand in pharmacology, Elliott said. "In contrast, if you want to prescribe chlorthalidone, you have to write out all 14 letters," he said.

Considering that 65 million people in the United States suffer from high blood pressure, writing out 'chlorthalidone' multiple times a day could take up a lot of physician time, he said.

Elliott, known for his witty and humorous commentaries, emphasized he was serious in saying that the ability to use the abbreviation results in patients getting inferior treatment for high blood pressure.

He presented documentation as proof:

-- A landmark 1982 study called MRFIT (Multiple Risk Factor Intervention Trial) in which patients treated with chlorthalidone achieved better outcomes than patients on hydrochlorothiazide diuretics.

-- In the Hypertension Detection and Follow-Up Program in 1976, Elliott noted that patients treated with hydrochlorothiazide had 44 percent more coronary heart disease and 16 percent more deaths, when compared with referred-care patients treated by primary care physicians; on the other hand there was 58 percent less coronary heart disease and 41 percent fewer deaths among patients treated with chlorthalidone, when compared with referred-care patients.

Overall, the study compared "stepped care" according to the study protocol with "referred care" provided, as determined by private-practice physicians.

-- In a third study that directly compared the two diuretics, published in 2006, Elliott noted that patients on chlorthalidone reduced blood pressure better than hydrochlorothiazide in several critical tests.

In his educational talk to physicians on how to use diuretics -- so-called water pills -- in regular practice, Elliott said patients with severe high blood pressure need to be on loop diuretics twice daily, while those with mild to moderate hypertension can use either chlorthalidone or hydrochlorothiazide.

However, he added that, in addition to clinical trials indicating a benefit to patients over hydrochlorothiazide, chlorthalidone appears to be more effective in patients with stage 3 hypertension -- patients who may soon require loop diuretics.

Suzanne Oparil, professor of medicine at the University of Alabama at Birmingham and president of the society, told UPI she wasn't convinced that the abbreviation was the reason doctors prescribed hydrochlorothiazide more than chlorthalidone.

"I believe that chlorthalidone is underutilized, particularly in patients with resistant hypertension," she said. "The drawback is that chlorthalidone is not available in many fixed-dose combination drugs so it is somewhat inconvenient to use. But I think it should rise higher on the radar screen."

"Patients would be better served," said John Flack, director of patient care at Wayne State University in Detroit, "if pharmaceutical companies would break their habit of just adding hydrochlorothiazide to their combination hypertension medications and consider adding chlorthalidone instead."