Newer Blood Pressure Drugs Beat Out Older Ones

Findings Contradict Previous Studies Showing Older Is Better

From the WebMD Archives

Sept. 6, 2005 (Stockholm, Sweden) -- Tens of thousands of heart attacks, strokes, and deaths could be prevented each year if people took a combination of newer high blood pressure drugs rather than the old standbys.

Additionally, the newer regimen may cut the risk of diabetes by about one-third, says researcher Bjorn Dahlof, MD, associate professor of medicine at the University of Goteborg in Sweden.

"The more modern therapy fared better than the older treatment in almost every regard," he tells WebMD.

Is Newer Really Better?

The new study does not agree with previous research showing that water pills (diuretics) were better at preventing heart failure and stroke than newer blood pressure drugs.

A landmark trial in 2002 showed that compared with the cheaper diuretic, people taking Norvasc had a 38% higher risk of developing heart failure and a 35% higher chance of being hospitalized with heart failure. Those on an ACE inhibitor, also a newer class of drugs, had a 15% higher risk of stroke, a 19% higher risk of developing heart failure, and other increased risks compared with people taking a diuretic.

In response to those previous findings, experts told WebMD in 2002 that doctors should begin drug treatment for high blood pressure with a diuretic.

Drugs Battle It Out

The new study, presented here at the annual meeting of the European Society of Cardiology, included more than 19,000 people with high blood pressure and at least three other heart disease risk factors, such as smoking and family history.

About half got Norvasc -- a member of the newer class of drugs known as calcium-channel blockers -- while the rest got atenolol, an older drug belonging to the class called beta-blockers. The study was funded by Pfizer, which manufacturers Norvasc. Pfizer is a WebMD sponsor.

If either of the drugs failed to lower blood pressure, another medication was added: People on Norvasc were also given the ACE inhibitor Aceon, while those on atenolol added a diuretic.

After 5.5 years, the trial was stopped prematurely when results showed the Norvasc-based treatment beat out the older approach: They were 23% less likely to have a stroke, 11% less likely to die, and 30% less likely to develop diabetes than people who took the beta-blocker. Both regimens were equally safe.

Additionally, 32% of the people with diabetes and 60% of those without diabetes achieved their blood pressure goals: less than 140/90 for patients without diabetes and 130/80 for patients with diabetes.

The study was simultaneously published online in The Lancet.

Blood Pressure or Something Else?

But overall, people who took Norvasc achieved blood pressures that were only about three points lower than those on beta-blockers, setting off a debate about whether blood pressure lowering or other factors are at play.

Researcher Neil Poulter, MD, professor of preventive cardiovascular medicine at Imperial College London in England, says blood pressure by itself can only explain 15% to 35% of the benefits seen in people taking Norvasc.

"There is unlikely a single explanation for why it worked so well, but it seems likely there are advantages beyond blood pressure lowering," he tells WebMD.

But Robert Bonow, MD, professor of medicine at Northwestern University in Chicago and past president of the American Heart Association, says, "This is primarily a blood pressure-lowering effect. Every study on hypertension has shown that even a small drop in blood pressure improves outcome."

Take-Home Message: Talk to Your Doctor

Tim Gardener, MD, a clinical professor of surgery at the University of Pennsylvania in Philadelphia, and an AHA spokesman, says, "We need to rein in a little enthusiasm about which drugs or combination of drugs is used."

Most importantly, he tells WebMD, "is that you individualize the treatment, arriving at the best drug or combination of drugs that treat that person's hypertension."

Patients can arm themselves with this new information and talk to their doctors about which blood pressure drug is best for them. Taking this, and previous information into account, doctors can best choose which treatment is best for their patients.

Show Sources

SOURCES: European Society of Cardiology Congress 2005, Stockholm, Sweden, Sept. 4-7, 2005. The Lancet, September 2005; vol 366: pp 895-906. Bjorn Dahlof, MD, associate professor of medicine, University of Goteborg, Sweden. Neil Poulter, MD, professor of preventive cardiovascular medicine, Imperial College London. Robert Bonow, MD, professor of medicine, Northwestern University, Chicago. Tim Gardener, MD, clinical professor of surgery, University of Pennsylvania, Philadelphia.
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