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.
But 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 also were 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 were so large that it would be unethical to continue.
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, also was published Sunday on the website of The Lancet medical journal.
