Newer drugs to reduce high blood pressure better than standard treatments


EMBARGO: 1600H (London time) Sunday September 4, 2005. In North America the embargo lifts at 11:00am ET Sunday September 4, 2005.

A combination of modern anti-hypertensive drugs can reduce a patient's risk of stroke and heart attack to a greater extent than standard treatments, conclude the results of a randomised trial published online today by THE LANCET.

Hypertension is the most important preventable cause of premature death in developed countries, and the benefits of antihypertensive drugs for prevention of cardiovascular mortality and morbidity are well established. However, no individual trial using standard diuretic or ß-blocker therapy, or both has shown a significant reduction in coronary heart disease. Previous studies have suggested that newer agents would confer advantages over diuretics and ß-blockers.

In the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), Bjorn Dahlof (Sahlgrenska University Hospital, Sweden) and colleagues compared the effect of combinations of older drugs--atenolol and thiazide--with newer drugs, amlodipine and perindopril. The investigators recruited 19, 257 patients aged between 40-79 years who had a least three other risk factors for cardiovascular events. Half of the patients were assigned the atenolol-based regimen and half the amlodipine-based regimen. After 5 years the investigators found those allocated the amlodipine-based regimen had lower blood pressure values than those on the atenolol -based regimen. They also found that the newer drugs prevented more major cardiovascular events and caused fewer cases of diabetes than the older drugs.

Dr Dahlof comments: "The preferential reduction in cardiovascular events associated with an antihypertensive regimen of a calcium-channel blocker (amlodipine) with addition of perindopril if necessary, particularly when used in combination with effective lipid lowering, results in the prevention of most major cardiovascular events associated with hypertension. We hope these results will be used to inform clinical practice in ways that should greatly reduce the burden of cardiovascular disease to which patients with hypertension are exposed."

In a second study Neil Poulter (Imperial College London, UK) and colleagues looked at differences in blood pressure and other variables in patients assigned the newer drugs versus those allocated the standard drugs. They found that a reduction in blood pressure was the single biggest contributor to the effect on stroke events, but other factors, such as differences in cholesterol, were more important for coronary events.

In an accompanying comment Jan Staessen (University of Leuven, Belgium) states: "On balance, the ASCOT results endorse the European guidelines for the treatment of hypertension, which leave the responsibility to choose the drug class to initiate antihypertensive to the doctor. ASCOT also supports the use of newer drugs, especially in patients with complicated hypertension, associated risk factors and/or metabolic disturbances…Governments and health care insurers will have to accept that the use of antihypertensive drugs cannot be rationed."

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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