Wednesday, November 01, 2006

Torcetrapib and Hypertension - Glass Half Empty?

It is interesting that Pfizer’s drug torcetrapib – a cholesterol lowering drug developed to raise HDL (or “good cholesterol”) – was found to raise systolic blood pressure by 2-4 millimeters of mercury. Wall Street and its analysts seem concerned. While it is useful in large trials to monitor important trends like this due to known risk factors of hypertension such as stroke, could this side effect be beneficial?

Many patients I see with severe New York Heart Association Class III or Class IV heart failure often have very low blood pressure, since their systolic function (or ability of the heart muscle to generate pressure) is compromised. It is well known that elevated blood pressure increases the myocardial work (and hence oxygen requirements). However, many of our treatments known to improve survival in patients with heart failure lower blood pressure significantly (like ACE inhibitors and beta blockers) to such an extent, their dosage has to be limited. Many a clinician would welcome a drug that might permit higher amounts of these known beneficial drugs to be used on their patients, provided there were no other adverse side effects in doing so.

I hope the FDA does not act too quickly here and disapprove this drug before more information regarding torcetrapib become available. There might be a benefit to seeing the glass half full instead of half empty.


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