March 31, 2008 (Chicago) -- A tablet that contains two different types of blood-pressure-lowering medications cuts the risk of heart attack, stroke, or death by one-fifth, when compared with an older combination drug, researchers report.
The drug, Lotrel, proved so effective at preventing cardiovascular disease and deaths that the study was halted early so all patients could be offered it.
"It's a clear win," says study researcher Kenneth Jamerson, MD, professor of internal medicine at the University of Michigan Medical School.
The study compared two combination pills, both of which contain the angiotensin-converting enzyme (ACE) inhibitor Lotensin. Lotrel combines Lotensin and the calcium channel Norvasc. The other pill contained Lotensin and a diuretic called hydrochlorothiazide.
1 in 3 Americans Have High Blood Pressure
People whose systolic numbers (that's the top number in your blood pressure reading) are 140 or higher or whose diastolic numbers (the bottom number) are 90 or higher are considered to have high blood pressure. One in three people, or more than 73 million Americans, fit the bill.
Often treatment begins with diet and exercise. If the blood pressure goal is not achieved, diuretics are commonly prescribed as the initial therapy for patients, either alone or in combination with another class of blood pressure-lowering medication.
Jamerson says the findings "should modify future guidelines for the treatment of hypertension," both in terms of starting with a one-drug strategy in some patients and starting with diuretics.
He notes that many patients find it more convenient to take a single-tablet combination of drugs rather than a handful, or even a couple, of different pills.
Combos Lowered Blood Pressure
The new study involved more than 11,000 people over 60 who had high blood pressure and other cardiovascular disease risk factors, such as obesity or diabetes.
Only 37% of participants had adequate blood pressure control at the start of the study.
By 36 months later, the average blood pressure in 80% of patients in both groups was less than 140 over 90, which is "excellent," Jamerson says.
Importantly, patients taking Lotrel were 20% less likely to die from cardiovascular disease, have a heart attack or stroke, be hospitalized for the chest pain of angina, or need a procedure to open blocked heart arteries.
American Heart Association President Dan Jones, MD, dean of the University of Mississippi School of Medicine in Jackson, tells WebMD that he hopes the findings will propel more "people to think about starting with combination therapy" to lower blood pressure.
Treatment with a single drug often isn't effective, he explains.
But Jones says more study is needed before he would conclude that a combination of an ACE inhibitor and a calcium channel blocker is the way to go.
"If you look at the totality of all the trials that have been done, the results are mixed. And right now the state of knowledge is that it is lowering blood pressure, not how you get there, that's the more important thing," Jones says.
"As a result, we should focus on whatever combination gets you to your target blood pressure without causing adverse events," Jones says. That could mean a combination of any of the five classes of drugs known to lower blood pressure; diuretics, ACE inhibitors, calcium channel blockers, beta-blockers, and angiotensin receptor blockers.