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Study suggests new drugs are better for treating high blood pressure

Provided by: Associated Press
Sep. 4, 2005

STOCKHOLM, Sweden (AP) - A combination of newer medicines is better at
lowering blood pressure and more effective at reducing the risk of heart
attacks and strokes than the more traditional combination of drugs, new
research suggests.

However the findings, presented Sunday at the annual conference of the
European Society of Cardiology, prompted debate because they contradict an
earlier study that found traditional diuretic-driven therapy was better than
newer drugs.

Experts were divided over whether the results of the study - led by Dr.
Bjorn Dahlof of Sahlgrenska University Hospital in Goteborg, Sweden - mean
that the newer pills are themselves more effective or whether the extra
benefit seen in the study reflects the possibility that patients getting the
newer pills were more likely to take their medication properly because there
are fewer side effects.

The study compared the effects of two combinations of blood pressure
medicine in 19,257 patients with hypertension, or high blood pressure.

About half the patients received the older combination: a beta blocker
called atenolol to slow the heart rate and a diuretic to reduce fluid in the
body. The other half received a pair of modern drugs: a calcium blocker
called amlodipine to slow the rate at which the heart pumps blood, coupled
with the ACE inhibitor perindopril, which lowers blood pressure by relaxing
vessels.

After five years, the scientists found that those taking the modern
combination had blood pressure levels on average 2.7 points lower than those
taking the more traditional medication.

Heart attacks, strokes and new diagnoses of diabetes were also less common
among those taking the newer drugs than in the traditional group. Strokes
were down 23 per cent, heart-related deaths were 24 per cent lower and new
diagnoses of diabetes were 30 per cent lower among the patients who got the
newer drugs.

There was no difference between the two groups when it came to
complications.

The study was stopped prematurely after five years when preliminary results
started to emerge because the safety committee believed the differences
between the two groups was so large that it would be unethical to continue.

Experts at the conference debated the question of why blood pressure was
lower with the newer drugs.

Some believed that the difference was attributable to the superiority of the
newer drugs, while others suspected it might be because the side effects of
the older drugs make people less likely to take their pills properly. Beta
blockers may cause sluggishness or sexual side effects, and diuretics can
lead to frequent urination.

Doctors also raised questions over whether the heart attacks, strokes and
deaths were lower with the newer drugs simply because blood pressure was
lower in that group, or whether the modern drugs have benefits beyond blood
pressure lowering, as suggested by the investigators.

"Perhaps some part of the difference is related to blood pressure reduction
and some part is due to other factors," said Dr. Salim Yusef, a
world-renowned heart disease researcher. "However, I believe the results."

"When you stop a study early . . . the results are probably more exaggerated
than the truth," said Yusef, a professor of medicine at McMaster University
in Hamilton, Ont. who was not involved with the research. "But is there a
real benefit of treatment here? The answer is yes. But is the size of the
benefit dependable? The answer is probably not."

The key lesson from this and previous studies on blood pressure, he said, is
that blood pressure must be aggressively lowered and that multiple drugs are
needed to successfully achieve that.

High blood pressure is the most important preventable cause of premature
death in developed countries. However, it is properly controlled in less
than 20 per cent of hypertensive people worldwide, experts say.

The older combination used in the study is the recommended initial strategy
in the United States. European guidelines, however, have for some time given
doctors wider discretion to choose whichever type of blood pressure lowering
drugs they want.

The study, funded mainly by Pfizer, which makes the new calcium blocker, was
also published Sunday on the website of The Lancet medical journal.