When the best treatment is wrong for you

By Richard Laliberte

updated 8:01 a.m. ET July 22, 2009

You hear the pitch in drug ads all the time: "Ask your doctor if this medication is right for you." Trouble is, in many cases the only way your doctor can answer the question is by having you try the drug. And, as the latest research reveals, what's "right" for the smiling folks in a TV commercial may be just plain wrong for you.

One reason: Each of us responds uniquely to any given medication. "Your liver and kidney function, overall health, treatment for other conditions, and genetics all play a role in how a drug affects you," says Martha Gerrity, MD, PhD, clinical evidence specialist at the Center for Evidence-Based Policy at Oregon Health & Sciences University.

Another reason: The chances of your having a good response are simply not in your favor. "To market a medication, all you have to do is prove that it's better, on average, than a sugar pill," says Mark Gibson, deputy director of the OHSU center. A drug that works 20 percent of the time, for instance, may be considered effective — even though it does nothing for 80 percent of patients.

Those odds could improve soon, thanks to a national push to comb through studies and scientific reviews to determine who gets better most often on which drugs. Called comparative effectiveness research, the initiative aims to produce a reliable set of guidelines that will enable you and your doctor to choose treatments based on solid evidence, not guesswork. The Obama administration has made comparative effectiveness research a priority, funneling over $1 billion — "a huge increase," says Gibson — into the program as part of the government's stimulus package.

Already, 28 research centers funded by the government's Agency for Health care Research and Quality (AHRQ) have produced a wealth of findings on treatments for many common, chronic conditions. If you suffer from one of them, first start with lifestyle changes such as exercise and a modified diet. Then, when you're ready to try drug treatment, talk to your doctor about the steps outlined here — all supported by powerful new research.

High blood pressure
If you're overweight, you can lower your blood pressure by losing just 5 pounds. And healthy strategies for dropping those pounds — exercising; consuming less saturated fat; and eating more fruits, vegetables, and whole grains — can each help tame hypertension. But you may still need medical treatment, depending in part on how high your blood pressure is.

First, try... a diuretic, which takes pressure off blood vessels by making the body eliminate water and sodium. "Many people with hypertension who take a diuretic alone are able to bring blood pressure down to a target of 130/90 or, ideally, 120/80, with relatively few side effects," says Gerrity.

If that doesn't work... take a two-pronged approach by adding a beta-blocker, ACE inhibitor, or angiotensin II receptor blocker (ARB), all of which work in a manner different from that of your diuretic.

Tailor your treatment
If you have diabetes or kidney problems: Make your second drug an ACE inhibitor, which protects the kidneys.

If you're African American: Consider starting with a combination treatment that includes a diuretic: African Americans generally don't respond as well to treatment with just one drug.

If blood pressure is really high: Start right away with combo treatment to quickly bring down systolic blood pressure if it's 160 or higher, or diastolic blood pressure if it's 100 or higher.

If you have ischemic heart disease (which can cause your pulse to be irregular or rapid): Instead of a diuretic, start with a beta-blocker, which can help lower your heart rate.

If you're pregnant: Avoid ACE inhibitors and ARBs; they can cause birth defects. Better choices: beta-blockers and vasodilators that relax blood vessels.

Go natural: Omega-3 fatty acids lower blood pressure, but only in high doses (above 3 g a day) that may increase your risk of bleeding, so take them only under a doctor's supervision. Coenzyme Q10 may also cause small drops in blood pressure and may lower blood sugar in some people, so be cautious if you're taking diabetes medication.

Type 2 diabetes
Diet, exercise, and weight control are among the most potent tools for bringing down high blood sugar. A 10-pound weight loss — even in someone who is obese — can help patients with diabetes as much as adding another medication, says Gerrity. A variety of drugs also effectively control blood sugar.

First, try... Metformin (Glucophage), which decreases the amounts of glucose absorbed from food and made by the liver. Metformin is older and cheaper than many other drugs, but it matches or outperforms the newer thiazolidinediones (Actos, Avandia), according to a new review.

If that doesn't work... combine metformin with a second drug, such as a sulfonylurea, which increases the body's insulin production. "Because metformin and sulfonylureas work in different ways, the drugs lower blood sugar together better than either drug would by itself," says Gerrity.

Tailor your treatment
If you're overweight: Stick to metformin; it won't make you gain weight.

If you have high cholesterol: Avoid Avandia and Actos, which can raise "bad" LDL cholesterol and worsen congestive heart failure, according to AHRQ reports. Opt for metformin, which can lower LDL.

If you have a sensitive stomach: Take a smaller dose of metformin, which is more likely than other diabetes pills to cause diarrhea and stomach cramps. If the lower dose proves less effective, combine metformin with a different drug to keep blood sugar under control.

Go natural: "Eat high-fiber, unprocessed foods, especially legumes," advises Kevin Barrows, MD, interim director of clinical programs at the Osher Center for Integrative Medicine at the University of California, San Francisco. Some reports suggest you can also lower blood sugar by taking the botanicals Gymnema sylvestre and bitter melon (but don't combine them with prescription meds).

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