updated 4/26/2004 6:27:53 PM ET 2004-04-26T22:27:53

Too many people with high blood pressure quit medication because they don’t feel bad — even though the disease is silently attacking arteries and organs. Now a drug giant is offering an extra incentive to stick with it: a money-back guarantee.

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Brands eligible for Novartis Pharmaceuticals’ unusual offer are more expensive than the type that hypertension patients are supposed to try first. And critics decry the program as a gimmick in the increasingly competitive market for blood-pressure treatment.

Yet the program is winning praise from the government, which will help in announcing it this week. It’s part of a broader anti-hypertension campaign where doctor and nurse groups will join Novartis in education and screening efforts, and federal health officials say they welcome anything to entice more Americans to get treated.

“If this really gets the attention of those who otherwise would not have tried to have their blood pressure under control, then it’s worthwhile,” says Dr. Barbara Alving, acting director of the National Heart, Lung and Blood Institute. “We have to look at it and say, ’What is the greater good to be obtained here?”’

The silent killer
Nearly 60 million Americans have high blood pressure, and almost a third don’t know it. It’s often called the silent killer because it may not cause noticeable symptoms until the patient has suffered serious damage leading to heart attacks, strokes, kidney failure, blindness, even dementia.

Normal blood pressure is less than 120 over 80. High blood pressure begins at 140 over 90, for diabetics, 130 over 80 — levels that require medication in addition to diet and exercise.

Two-thirds of patients don’t have their blood pressure under control, partly because many doctors are reluctant to prescribe the multiple drugs most require — and partly because many asymptomatic patients quit their pills.

Novartis’ “Take Action for Healthy Blood Pressure” program offers people whose doctors agree:

  • A free 30-day trial of either Novartis’ Diovan, Diovan HCT or Lotrel, among the biggest-selling antihypertensives.
  • A free blood pressure monitor.
  • Reimbursement of four months of out-of-pocket drug costs if, after trying the highest doses of Diovan HCT or Lotrel, the patient doesn’t reach his or her doctor-set blood pressure goal.

“This is a goofy idea,” says Dr. Jerry Avorn of Harvard’s Brigham and Women’s Hospital.

Avorn co-authored a recent study that concluded the nation could save $1.2 billion if doctors followed federal guidelines in prescribing cheaper antihypertensives over more expensive competitors. “It pushes therapy in a direction that is counter to what a lot of current research suggests is appropriate.”

How strokes happenThose guidelines say that diuretics, a type of old and cheap medication, should be attempted first — but that most patients ultimately will require at least two drugs.

Diovan is a newer drug called an angiotensin II antagonist. Diovan HCT adds a diuretic to control blood pressure. Lotrel combines the ACE inhibitor benazepril — a drug that decreases chemicals that tighten blood vessels — with the calcium channel blocker amlodipine — which relaxes blood vessels. It is perhaps best known as competitor Pfizer Inc.’s Norvasc, a top-selling antihypertensive.

Novartis, which calls the drug offer a patient confidence booster, won’t say how much it’s spending on the campaign or how much it stands to earn.

But it stresses that the effort also includes no-strings-attached hypertension information via a Web site and doctor-provided brochures. Also signing on are groups like the American Nurses Association, which plans blood-pressure screenings — and the American Society of Hypertension, which doesn’t endorse any drug but says the campaign will help it increase doctor training.

Doctors must consider a diuretic first in any patient interested in Novartis’ program, stresses American Heart Association spokesman Dr. Dan Jones, the University of Mississippi’s dean of medicine.

But some people aren’t candidates for diuretics — and while two Novartis ingredients, the diuretic and benazepril, are available as cheaper generics, combination products allow some insured patients to pay one co-pay, he notes.

“For a lot of people, money is part of the decision,” said Jones, adding that the offer may indeed be good for public health.

Take Milton McDonnell, a diabetic who says he simply never considered medication despite having blood pressure of 155 over 75 for several years. Last week, his doctor showed him the guarantee, persuading him to try.

“They must be pretty sure of their product,” says McDonnell, 61, of Puyallup, Wash.

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