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Newer Drugs Touted in Heart-Stroke Study

Posted on: Monday, 5 September 2005, 15:00 CDT

STOCKHOLM, Sweden -- 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, major 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 superior to 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 percent, heart-related deaths were 24 percent lower and new diagnoses of diabetes were 30 percent 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 Canada 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 percent 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 Web site of The Lancet medical journal.

Source: Deseret News (Salt Lake City)

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