Associated Press

SANTA FE, N.M. — Studies find that doctors frequently fail to prescribe some lifesaving older drugs for their patients with bad hearts and high blood pressure, while overusing newer, less effective medicines.

The research is the latest to lament the slow, often erratic way that new medical knowledge makes its way into everyday practice, as well as the influence of drug company marketing campaigns.

Doctors say the result is often less-than-ideal treatment with overpriced drugs.

Virtually every set of guidelines issued by expert panels lists an older class of drugs called beta blockers as the first-line treatment for recovering heart attack victims and others with serious coronary artery disease.

However, one of three new studies released Friday by doctors from Massachusetts General Hospital in Boston shows that use of these drugs actuallv decreased during the 1980s. At the same time, doctors began prescribing a new variet of medicines, called calcium channel blockers, that experts say are not as effective.

"Appropriate, proven medica tions for the treatment of heart disease are not being adopted into practice," said Randall, S. Stafford, one of the Boston doctors.

Stafford and Dr. Thomas Wang presented the results at an epidemiology conference sponsored by the American Heart Association.

Beta blockers, along with diuretics, are also considered to be the best treatments for high blood pressure.

They are often available in generic form and cost pennies a day. But many doctors instead prescribe calcium blockers, which came into widespread use in the late 1980s. These drugs are still largely protected by patents and often cost $2 or $3 a day.

The researchers reviewed drug company advertising in 210 issues of the weekly New England Journal of Medicine, a magazine aimed at doctors.

In 1985, 12 percent of the advertising was for beta blockers, 5 percent for calcium blockers and 4 percent for diuretics. By 1996, 27 percent of the magazine's drug ads were for calcium blockers. The journal did not carry a single ad for beta blockers or diuretics that year.

Wang said he believes that this and other promotions – such as free samples, visits by drug salesmen and education programs sponsored by drug companies at least partly explain the underuse of beta blockers.

He reviewed data from 11,000 patient visits compiled in 1980 and 1981 and again from 1993 to 1996. In the early 1980s, 30 percent of patients visiting doctors with coronary artery disease were prescribed beta blockers. By the mid-1990s, this had fallen to 21 percent.

At the same time, he said, use of calcium channel blockers surpassed beta blockers. However, use of calcium blockers has dropped back to about the same level as that of beta blockers for people with coronary disease, at least in part because of troublesome evidence that some forms of calcium blockers might actually be harmful.

Common brands of beta blockers include Inderal and Lopressor. Calcium blockers include Procardia and Norvasc.

The doctors said that, despite scientific studies in medical journals and guidelines issued by expert panels, many doctors simply do not know which medicines are best.

"The last step after coming up with the science is getting the message out there. There are significant shortfalls," said Dr. Thomas Pearson of the University of Rochester.